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

Adjunctive therapies such as statins have been proposed to reduce recurrence rates in chronic subdural hematoma (CSDH).

Does pre-existing statin therapy influence CSDH recurrence after middle meningeal artery embolization (MMAE), with or without surgical evacuation?

We retrospectively analyzed all patients who underwent MMAE for CSDH between January 2020 and October 2021 at a university hospital with a neurovascular focus. Indications were: salvage after recurrence without additional surgical drainage, first-line MMAE in patients at high surgical risk, adjunct after surgical drainage, and salvage after recurrence with additional drainage. Statin exposure referred to statins documented before MMAE and not discontinued during follow-up.Data included clinical variables, adjunctive statin and CT-based hematoma characteristics.Clinical therapy failure required radiological recurrence plus new neurological symptoms. Analyses were descriptive and exploratory.

A total of 47 CSDHs in 38 patients (9 bilateral) were treated. Clinical failures occurred in 3/47 (6.4 %) overall, by indication: 2/13 (15.4 %) salvage-without-drainage, 1/15 (6.7 %) first-line MMAE, 0/6 (0 %) adjunct-after-drainage, 0/13 (0 %) salvage-with-drainage.Statins were administered in a subset of patients. The overall recurrence rate was 6.4 %. No significant association was found between statin exposure (18/47, 38.3 % and recurrence.One patient died from contrast-induced anaphylaxis prior to embolization; no intraprocedural device related complications were recorded.

In this cohort, statin use was not associated with reduced recurrence after MMAE. Combined surgery plus MMAE showed no observed recurrences, whereas events occurred after MMAE alone. Given the small sample these results are exploratory and require prospective confirmation.