Abstract
INTRODUCTION:Chronic subdural hematoma (cSDH) causes a significant burden of disease and plagued by hematoma recurrence after surgical evacuation, particularly in septated cSDH. Middle meningeal artery embolization (MMAE) has emerged as a promising treatment both as an adjunct to surgery and as a primary treatment.METHODS:This a single center, retrospective cohort study of patients treated with surgery for septated cSDH. Patients in the surgery + MMAE cohort were identified from a prospectively collected MMAE registry and compared to a historical surgery cohort presenting over a 2-year period prior to the introduction of MMAE in our institution. Included patients had evacuation of septated cSDH with either burrholes or craniotomy. CT imaging was assessed hematoma width and midline shift perioperatively and at follow up. The primary outcome was reoperation and secondary outcome recurrence and change in hematoma depth and midline shift.RESULTS:A total of 34 cSDHs in 23 patients (MMAE + surgery) and 94 cSDHs in 76 patients (surgery) met the inclusion criteria. No significant differences of baseline characteristics was identified.The rate of reoperation was significantly higher in the surgery cohort (n = 16) compared with the surgery + MMAE cohort (n = 0) (p = 0.006).CONCLUSIONS:MMAE for septated cSDH was found to be highly effective in preventing recurrence and reoperation. MMAE is an adjunct to surgical evacuation may be of particular benefit in this patient cohort.