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Updated: Sep 17, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Single-Session Middle Meningeal Artery Embolization With Concomitant Evacuation Surgery for Chronic Subdural
Santiago Gomez-Paz1, Kent Richter2, Maggie McGrath3
1Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City , Utah , USA.
Background And Objectives:
Middle meningeal artery embolization (MMAE) is a safe and efficacious adjunct to surgical evacuation for symptomatic chronic subdural hematoma (cSDH). We evaluated the concomitant performance of MMAE with surgical evacuation in a single anesthetic session rather than a staged approach.
Methods:
In this retrospective, multicenter cohort study, patients with cSDH who underwent MMAE and surgical evacuation during 1 anesthetic session from January 2020 through August 2024 were included. The primary endpoints were feasibility (technical success), safety (complication and mortality rates), and efficacy (radiographic improvement and modified Rankin Scale score ≤2).
Results:
Among 157 patients (median age 74 years), 66% had unilateral cSDH and 34% had bilateral disease. Technical success was achieved in 153 patients (97.4%), with no major intraprocedural failures. The overall complication rate was 10.8%, including intraprocedural complications (ie, vessel injuries, cardiac arrest) in 4 patients (2.5%) and periprocedural adverse events in 13 patients (8.3%), including seizures, hemorrhages, respiratory failure, ischemic events, infections, and recurrent hematomas. The overall mortality rate was 12.7% (6 [3.8%] early postoperative deaths, 13 [8.3%] late unrelated deaths). Radiographic improvement was observed in 91.7% of patients, with 63.1% achieving ≥50% reduction in hematoma thickness at last available follow-up. At median follow-up of 54 days, 99/118 (83.9%) patients achieved or maintained functional independence (modified Rankin Scale ≤2).
Conclusion:
Single-session MMAE with concomitant surgical evacuation proved feasible and safe. Radiographic and clinical outcomes were favorable, without higher complication rates compared with staged approaches. Future prospective studies should clarify the long-term benefits, assess the impact on resource use and cost-minimization, and determine ideal patient-selection criteria for this integrated treatment strategy.
