Background Chronic subdural hematoma (cSDH) management in cancer patients is complicated by altered coagulation and bleeding risk. The role of middle meningeal artery embolization (MMAE) in this population remains undefined. Objective To compare outcomes of MMAE versus standard care in cancer patients with cSDH. Methods We conducted a retrospective cohort study using the TriNetX Analytics Network, identifying adults (≥18 years) with cSDH and cancer from inception‐May 2025. Patients underwent either MMAE or standard care. Propensity score matching (1:1) balanced baseline characteristics. Primary outcomes included all‐cause mortality, recurrence, and reintervention at 6‐60 months. Secondary outcomes included hematoma resolution, readmission, and complications. Results Of 37,966 patients, 311 underwent MMAE and 37,655 received standard care. After matching, 250 pairs were analyzed. At 6 months, MMAE significantly reduced recurrence (6.4% vs 14.8%, RR 0.43, p=0.002) and reintervention (5.6% vs 12.4%, RR 0.45, p=0.01), with no mortality difference (15.6% vs 19.6%, RR 0.80, p=0.25). At 60 months, recurrence (10.8% vs 18.8%, RR 0.57, p=0.01) and reintervention (9.2% vs 19.6%, RR 0.47, p=0.001) remained lower. Subgroup analyses showed consistent benefit across solid tumors, <75 years, and ≥75 years. Adverse events were comparable (stroke: 2.4% vs 1.2%, p=0.32). Conclusion MMAE significantly reduced recurrence and reintervention in cancer patients with cSDH without increasing complications, supporting its use in this high‐risk population. image
Alhasan et al. (2025) studied this question.