Middle Meningeal Artery Embolization for Recurrent Chronic Subdural Hematoma

Area of Science:

• Neurosurgery
• Interventional Radiology
• Vascular Surgery

Background:

• Recurrent chronic subdural hematoma (CSH) often necessitates repeated surgical interventions.
• Existing surgical treatments for recurrent CSH have a high rate of secondary recurrence.
• Middle meningeal artery embolization (MMAE) presents a potential alternative to conventional retreatment.

Purpose of the Study:

• To evaluate the efficacy and safety of MMAE compared to conventional retreatment for recurrent CSH.
• To assess the rates of second recurrence, complications, and neurological recovery in patients undergoing MMAE versus conventional retreatment.

Main Methods:

• Retrospective review of 142 patients with recurrent CSH (46 treated with MMAE, 96 with conventional retreatment).
• Primary outcome: second recurrence (imaging or clinical events).
• Secondary outcomes: complications and neurological recovery (modified Rankin scale).

Main Results:

• Significantly lower second recurrence rate in the MMAE group (2.2% vs 33.3%, adjusted OR 0.056, p=0.001).
• No significant difference in complication rates between groups (2.2% vs 10.4%, adjusted OR 0.203, p=0.103).
• Higher rate of neurological recovery in the MMAE group (69.6% vs 47.9%, adjusted OR 3.147, p=0.020).

Conclusions:

• MMAE is an effective and safe retreatment option for recurrent CSH.
• MMAE significantly reduces the risk of second recurrence and enhances neurological recovery.
• MMAE should be considered as a viable alternative to conventional retreatment for recurrent CSH.