Particle Embolization of the Middle Meningeal Artery for Subdural Hematoma: Efficacy and Cost Considerations

Subdural hematoma (SDH) is an increasingly common pathology. Middle meningeal artery embolization (MMAE) is an endovascular procedure shown to be efficacious in treating chronic subdural hematoma. This study aims to explore the efficacy of MMAE using polyethylene vinyl (PVA) particle and highlight cost effectiveness.

A single-center retrospective review was conducted. Patients who underwent MMAE from 2020 to 2022 were included. Demographics, medical history, symptoms on presentation, procedural details, and radiographic variables were collected. Rescue surgical evacuation and decreased SDH thickness by 50% were the primary end points.

Fifty-nine patients were included, with 43 male and 16 female patients, with an average age of 72.9 ± 9.6 years. Preprocedure SDH thickness was 14.7 ± 6.2 mm and midline shift was 6.2 ± 4.5 mm. Thirty-one patients (52.5%) were on home antiplatelet medications; 19 patients (32.3%) were on anticoagulants. PVA particles were the only embolisate used. Three patients underwent general anesthesia, and monitored anesthesia care was utilized for the rest. Postprocedurally, 4 patients required rescue surgical intervention (6.8%). Fifty-four (91.5%) patients had a decrease in SDH size by at least 50% at the last follow up visit. No patients had neurological deterioration postprocedurally.

This study suggests PVA for primary treatment of chronic subdural hematoma is safe and effective. The cost of 45-150 micron PVA particles is $153, compared with a vial of Onyx, which is $3334. Large-scale trials comparing embolic agents are necessary to assess for efficacy and safety in the setting of cost differences.