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Chronic subdural hematoma management with MMA embolization ± surgery: Pre-existing statin therapy did not reduce

Fee Christiane Keil1, Emma Becke1, Rejane Golbach2

  • 1Goethe University Frankfurt, University Hospital, Institute of Neuroradiology Frankfurt am Main, Germany.

Brain & Spine
|January 14, 2026
PubMed

Insights

Pre-existing statin therapy did not reduce chronic subdural hematoma (CSDH) recurrence after middle meningeal artery embolization (MMAE). Surgery combined with MMAE showed no recurrence, unlike MMAE alone, but further research is needed.

Area of Science:

  • Neurosurgery
  • Interventional Neurology
  • Vascular Neurology

Background:

  • Chronic subdural hematoma (CSH) recurrence is a clinical challenge.
  • Statins are explored for their potential to reduce CSH recurrence rates.
  • Middle meningeal artery embolization (MMAE) is an emerging treatment for CSH.

Purpose of the Study:

  • To investigate whether pre-existing statin therapy influences CSH recurrence after MMAE.
  • To compare recurrence rates between MMAE alone and combined surgical evacuation plus MMAE.

Main Methods:

  • Retrospective analysis of 47 CSH cases treated with MMAE between January 2020 and October 2021.
  • Statin exposure was defined as documented use before MMAE and continued during follow-up.
  • Clinical therapy failure was defined as radiological recurrence with new neurological symptoms.

Main Results:

  • The overall recurrence rate was 6.4% (3/47 cases).
  • Statin use (in 38.3% of patients) was not significantly associated with reduced recurrence.
  • No recurrences were observed in cases treated with combined surgery and MMAE, while MMAE alone had events.

Conclusions:

  • Statin use was not associated with reduced CSH recurrence in this cohort undergoing MMAE.
  • Combined surgical evacuation and MMAE demonstrated a potential benefit by avoiding recurrence.
  • These exploratory findings necessitate prospective studies for confirmation due to the small sample size.
Abstract

Keywords:
Adjunctive statin treatmentCSDHChronic subdural hematomaEmbolization of the middle meningeal arteryMMAE

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