1142. Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: Meta-Analysis and Systematic Review

Authors: Aditya Srivatsan; Alina Mohanty; Fábio Nascimento, MD; Muhammad Hafeez, MD; Visish Srinivasan, MD; Ajith Thomas, MD; Stephen Chen, MD; Jeremiah Johnson, MD; Peter Kan, MD (Sugar Land, TX)

Introduction: Chronic subdural hematoma (CSDH) is one of the most common diseases in neurosurgery. Though conventional surgical methods like burr-hole irrigation have been the mainstay of treatment, middle meningeal artery (MMA) embolization has recently emerged as a promising adjunctive or alternative treatment. We present the first meta-analysis and systematic review on this topic. Methods: A literature search using the keywords “chronic subdural hematoma”, “chronic subdural hemorrhage”, “refractory subdural hematoma”, “refractory subdural hemorrhage”, or “middle meningeal artery embolization” was conducted through October 2018. Outcome variables of hematoma recurrence, surgical complications, and Modified Rankin Scale (mRS) were analyzed and compared between MMA embolization and conventional surgery cohorts. Results: Three dual-armed studies that compared embolization and conventional surgery groups and six single-armed case series were identified and analyzed. Hematoma recurrence rate was significantly lower in the embolization group compared to the conventional treatment group (2.1% vs 27.7%, OR .087, 95% CI .026-.292, p<.001, I 2 =0%), whereas surgical complication rates were similar between the two (2.1% vs 4.4%, OR 0.563, 95% CI 0.107-2.96, p=.497, I 2 =27.5%). Number of patients with mRS>2 in the embolization (12.5%) versus conventional treatment (9.1%) groups showed no statistical difference (p=.689). A composite hematoma recurrence rate of 3.6% was found after summing the six case series. Composite recurrence and complication rates in the embolization cohorts of the dual-armed studies as well as the case series were also lower than literature values for conventional surgical treatments. Conclusion: Our results highlight the therapeutic potential of MMA embolization in CSDH and advocate for future prospective, randomized controlled trials on this promising therapy.