Elective outpatient middle meningeal artery embolization for chronic subdural hematoma is safe

Middle meningeal artery embolization (MMAE) is a safe and effective treatment for chronic subdural hematoma (cSDH); however, the appropriate level of postoperative care is unknown.

To evaluate whether elective MMAE for cSDH could be safely performed in an outpatient setting.

This was a multicenter, retrospective study of patients with cSDH who underwent elective MMAE. Patients were categorized as either inpatient (admitted for ≥1 night of hospitalization after MMAE) or outpatient (discharged on the same day of MMAE). Patient demographics, radiological data, procedural details, and follow-up data were collected. The primary endpoint was periprocedural complications, and secondary outcomes included emergency department (ED) visits or unplanned readmission within 24 hours, 1-7 days, and 8-30 days after MMAE.

Elective MMAE procedures were carried out in 190 patients, of which 45.3% (n=86) were outpatient procedures and 54.7% (n=104) inpatient. There were 7 (3.7%) periprocedural complications (one outpatient, six inpatient; P=0.12). Five patients presented to the ED and were readmitted within 24 hours of MMAE (three outpatient, two inpatient). Six patients presented to the ED 1-7 days after MMAE (three outpatient, three inpatient); three were subsequently admitted (one outpatient and two inpatient). Nine patients presented to the ED 8-30 days after MMAE (two outpatient and seven inpatient); three were subsequently readmitted (all inpatient). No elective outpatient MMAE resulted in a readmission attributable to the procedure within the examined time frame.

Elective MMAE can be safely performed as an outpatient procedure without increased risk of postprocedural adverse events in most eligible patients with cSDH.