1208. Safety and Efficacy of Embolization for Chronic Subdural Hematoma; a Case Series and Systematic Review

Authors: Muhammad Waqas, MBBS; Kunal Vakharia; Eisa Hashmi; Peter Weimer; Hussain Shallwani, MBBS; Jason Davies, MD, PhD; Adnan Siddiqui, MD, PhD; Andrew Gong (Buffalo, NY)

Introduction: Chronic subdural hematoma (CSDH) has a high rate of recurrence after surgical evacuation. It is recognized that inflammatory response of the dural layer, neovascularization and formation of inflammatory membranes contribute to the accumulation of CSDH . Embolization of middle meningeal artery (MMA) has been proposed for the treatment of CSDH. The purpose of this study was to systematically review the literature on the safety and efficacy of MMA embolization for the treatment of CSDH and share our experience of embolization for CSDH Methods: This systematic review was registered with PROSPERO and complies with PRISMA guidelines. PubMed, CINAHL, EMBASE and Cochrane were searched using MeSH terms for MMA embolization and chronic subdural hematoma. All the articles describing the use of MMA embolization for CSDH were included irrespective of the study design. Articles in non-English literature were excluded. Search period was 1 st January 2000 to June 2018. Consecutive patients who underwent embolization of MMA at our hospital were included. Results: Fifteen studies and 135 patients were included in the review. 53 (39.25%) underwent upfront embolization of the MMA, while 82 patients (60.74%) underwent embolization for recurrent CSDH. Three patients developed recurrence after MMA embolization i.e.,2.22%. No procedure related complication was reported. Various materials have been used for embolization including PVA, NBCA, Gelatin and coils. PVA however, was the most commonly used material. Institutional case series included 8 patients. All patients had symptomatic relief. No recurrence or procedure related complications were observed. Conclusion: The rate of recurrence of CSDH after MMA embolization is 2.22%, no other complication of MMA embolization has been reported in literature. The procedure therefore is safe and effective for the treatment of CSDH with or without surgical evacuation.