Middle Meningeal Artery Embolization in Subdural Hematomas: Does the Timing Matter?

Middle meningeal artery embolization (MMAE) effectively reduces the recurrence of subdural hematoma (SDH). The aim of this study was to determine the extent to which MMAE timing influences the reduction or recurrence of SDHs.

A retrospective analysis of patients undergoing MMAE, either as a stand-alone treatment or in combination with surgery, was performed. Hematoma width was measured at diagnosis, pre-embolization, and the last follow-up computed tomography of the head (CTH). Mixed-effects regression modeling was used to identify and evaluate changes in hematoma size over time.

Of the 145 patients undergoing MMAE, 45 were stand-alone and 100 were in combination with surgery. The mean SDH width was 14.4 mm at diagnosis, 10.3 mm pre-embolization, and 3.76 mm at final follow-up. The median time from diagnosis to embolization was 33.7 days (IQR: 54) and from embolization to final CTH was 105 days (IQR: 157). Final SDH width showed no significant association between the time from diagnosis to embolization (β = -0.001, 95% CI [-0.005, 0.003], P = .646). However, a more extended period between embolization and final CTH was associated with a more significant reduction in hematoma width (β = -0.002, 95% CI [-0.003, -0.001], P < .001). Greater pre-embolization width was associated with a larger residual at follow-up (β = 0.06, 95% CI [0.04, 0.08], P < .001). Rescue surgery was required in 4% of the surgery group and 11% in the stand-alone group (P = .136).

Timing from diagnosis to embolization does not impact radiographic improvement. Pre-embolization hematoma size and timing of postembolization follow-up are stronger predictors of radiological outcome. Low rescue surgery rates were noted overall.