Evaluating ICU Admission Necessity After Middle Meningeal Artery Embolization for Chronic Subdural H

INTRODUCTION/PURPOSE Chronic subdural hematoma (cSDH) is a common neurosurgical condition. Middle meningeal artery embolization (MMAE) has emerged as an effective adjunct to surgical evacuation, shown to reduce hematoma recurrence without increasing adverse events. However, the necessity of routine post‐procedural intensive care unit (ICU) admission remains unclear. We performed a retrospective review to evaluate the safety profile of MMAE and determine the cost‐effectiveness of ICU admission following the procedure. MATERIALS AND METHODS We conducted a retrospective, single‐center study with patients who underwent MMAE between January 2024 and May 2025. Demographic and procedural data were collected. Primary outcomes included ICU length of stay, MMAE‐related adverse events (AEs), serious adverse events (SAEs), and cost analysis. Emergency department (ED) visits and readmissions were analyzed for patients discharged within 24 hours of ICU admission. Results 73 patients were included, median age was 79 years (IQR: 69‐84), and 76.7% were male, the median ICU length was 2 days (IQR: 1‐2). Two patients (2.7%) experienced procedure‐related AEs, both presenting as self‐limited, medication‐responsive seizures. No SAEs occurred. Of thirty‐two patients discharged from the ICU within 24 hours, none returned to the ED within 24 hours; one returned within 1‐7 days (not admitted), and two returned within 8‐30 days (both admitted). The average total direct cost per day for an MMAE patient is $1,509 in the ICU versus $438 per day in a non‐ICU unit. Conclusion Routine ICU admission following elective MMAE appears to increase costs unnecessarily. With a low complication rate and high procedural safety, selective use of ICU beds may reduce healthcare costs without compromising patient outcomes. Prospective studies are needed to support the transition toward outpatient MMAE.