Embolization of Middle Meningeal Artery for Chronic Subdural Hematoma in 26 Patients

Introduction Distal penetration of chronic subdural hematoma's microvascular bed with liquid embolics or particles is often the goal of middle meningeal artery embolization (MMAe), but there is growing evidence that embolization with coils may have similar efficacy. Data supporting this approach is limited to self‐reported outcomes. Methods A multicenter registry of patients who underwent MMAe with Penumbra SwiftPAC coils was reviewed. Patients were excluded if coils were used as an adjunct to liquid embolics or particles. The primary outcome was hematoma recurrence or growth requiring re‐treatment within 180 days of MMAe. Secondary outcomes included hematoma thickness, hematoma volume, and midline shift (MLS) reduction, which were core lab adjudicated (New England Imaging Core Lab). Results A total of 31 embolizations performed on 26 patients from 3 institutions were included. The mean (± SD) age was 74 years (± 11.3) and most patients were male (73%). Most patients underwent up front hematoma evacuation (69%). The median (IQR) MMAe procedure duration was 31 minutes (29 ‐ 61) and most procedures were performed under general anesthesia (72%) with radial access (65%). There were 2 patients (7.7%) who required re‐treatment within 180 days. The mean radiographic follow‐up duration was 77days. The median (IQR) preoperative and postoperative hematoma thicknesses were 15.2 mm (12.7 ‐ 17.6) and 6.3 mm (0 ‐ 9.9), respectively. The median (IQR) preoperative and postoperative hematoma volumes were 71.4 cc (55.1 ‐ 107.8) and 6.6 cc (0 ‐ 35.1), respectively. Complete resolution was achieved for 11 (35.5%) hematomas and ≥ 50% reduction in thickness or volume was achieved for 24 (77.4%) hematomas. Complete MLS resolution occurred in most cases (90.3%). There were no procedural complications. Conclusion Preliminary core lab adjudicated data suggests primary coil embolization is a safe and effective approach for MMAe, but additional studies with large sample size are required.