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Middle Meningeal Artery Embolization for Chronic Subdural Hematoma in Cancer Patients: A Propensity-Matched Cohort
Muhammed Amir Essibayi1, Anthony Terraciano2, Jay Kakadiya2
1From the Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab (M.A.E., A.T., B.D., D.J.A.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neuroradiology (J.K., V.D., A.Y.A., H.J., D.A.L.), Rockefeller Neuroscience Institute,West Virginia University, Morgantown, WV; Department of Neurological Surgery (A.A.), University of Illinois Chicago, Chicago, IL, USA; Department of Neuroradiology (H.A.S.), MD Anderson Medical Center, Houston, TX 77030, USA; Division of Neurointerventional Surgery (H.C., D.G.,), Department of Neurosurgery, University of Maryland Medical Center, Baltimore, MD; Department of Interventional Radiology (M.C.), Oregon Health and Science University, Portland, OR and Department of Radiology (A.M.), Yale New Haven hospital, New Haven CT. m.amir.essibayi@gmail.com muhammedamir.essibayi@einsteinmed.edu.
Background:
Cancer patients with chronic subdural hematoma (cSDH) face higher recurrence and surgical risk. Middle meningeal artery embolization (MMAE) has emerged as a minimally invasive treatment for cSDH, but evidence is limited as cancer patients are mostly excluded from trials.
Methods:
Using the TriNetX US Collaborative Network, we identified adults with nontraumatic cSDH and a neoplasm diagnosed within one year before the index event. We performed four 1:1 propensity-score-matched comparisons: MMAE versus medical management and surgery plus MMAE versus surgery alone (both within cancer patients), and cancer versus no cancer within the medically managed and surgical cohorts. Outcomes were 90-day all-cause mortality and rescue surgery, assessed with Kaplan-Meier estimates and Cox proportional-hazards models.
Results:
Among cancer patients, MMAE versus medical management (694 matched pairs) was associated with lower 90-day mortality (15.3% vs 20.9%; HR 0.69, 95% CI 0.53-0.89; p=0.004), with no significant difference in rescue surgery (6.8% vs 4.5%; p=0.10). Adding MMAE to surgery (355 pairs) was associated with fewer rescue operations (8.8% vs 13.7%; HR 0.63, 95% CI 0.40-0.99; p=0.04) and numerically lower mortality (10.4% vs 13.4%; p=0.19). Cancer was associated with higher mortality among medically managed patients (18.5% vs 15.8%; p<0.001) and higher rescue surgery among surgical patients (14.9% vs 11.4%; p<0.001).
Conclusion:
MMAE was associated with a lower need for repeat surgical intervention in cancer patients with cSDH without raising mortality or complications. It is a safe, minimally invasive alternative to repeated surgical drainage for this high-risk group.