A new multicenter study found that the timing of middle meningeal artery embolization in relation to surgery for chronic subdural hematoma may not affect patient outcomes, including recurrence and technical success rates.
The investigators analyzed 266 middle meningeal artery embolization (MMAE) procedures performed in 237 patients at 10 U.S. centers between September 2018 and September 2023. All patients underwent surgical evacuation of chronic subdural hematoma (cSDH), with MMAE performed either preoperatively or postoperatively. The investigators aimed to assess whether the timing of embolization influenced outcomes such as cSDH recurrence, technical success, or radiographic improvement.
Among the procedures, 32% (n = 85) of them were performed prior to surgery and 68% (n = 181) of them were performed following surgery. The median patient age was 73 years, and 73.8% were male.
After adjusting for baseline characteristics using propensity score matching, no statistically significant differences were found between the groups. Reoperation as a result of recurrence occurred in 8% of patients who underwent MMAE prior to surgery and 4% of those treated after surgery (P = .90). Technical success was achieved in 100% of the patients in the preoperative group and 98% of those in the postoperative group (P = .31).
“The cohort did not show statistically significant differences in technical success or reoperation rates based on the timing and order of MMAE relative to surgical evacuation, although larger studies are needed to confirm these observations and rule out smaller, clinically meaningful differences,” said lead study author Georgios S. Sioutas, of the Department of Neurosurgery at the Perelman School of Medicine at the University of Pennsylvania, and colleagues.
The investigators also examined whether the interval between surgery and MMAE—within 2 days vs 3 to 7 days—affected outcomes. However, no statistically significant differences were observed in recurrence or technical success between these groups.
In unmatched analysis, some secondary outcomes appeared more favorable in the preoperative group, including greater hematoma thickness reduction and radiographic success. However, these differences were no longer statistically significant after controlling confounding variables.
Across the full cohort, technical success was achieved in 98.1% of procedures. Ethylene vinyl alcohol copolymer was the most used embolic agent (52.3%), followed by particles, coils, and n-butyl cyanoacrylate. Complications occurred in 3.8% of cases, including ischemic and hemorrhagic events, visual changes, encephalopathy, and one instance of cardiac arrest.
Craniotomy was the most frequent surgical approach (54%), followed by burr hole evacuation and subdural evacuating port systems. At baseline, 72% of the patients were functionally independent, defined as a modified Rankin Scale score of 0 to 2.
Although the investigators suggested scheduling flexibility for MMAE in the perioperative period, it was underpowered to detect small but potentially meaningful differences. They emphasized the need for larger studies to further investigate timing-related effects.
The investigators concluded that the order and timing of MMAE didn't significantly influence recurrence or procedural success when used alongside surgical evacuation for cSDH.
Full disclosures are available in the published study.
Source: Radiology
