2082 Middle Meningeal Artery Embolization in 108 Chronic Subdural Hematoma in Thrombocytopenic Cancer Patients

INTRODUCTION: Chronic subdural hematoma (cSDH) is common in cancer patients with thrombocytopenia associated with cytotoxic treatment effects. Cancer patients are often poor open surgical candidates. Emerging data suggests that middle meningeal artery embolization (MMAE) may have a role as stand-alone therapy. METHODS: We performed a retrospective review of MMAE for cSDH performed in a 5-year period in patients with cancer and evaluated clinical outcomes. RESULTS: Eighty-one patients with one-hundred-and-eight cSDH underwent MMAE. All patients had a cancer diagnosis and 70/81 patients received oncologic treatment within 6 weeks of the cSDH diagnosis. 69/81 patients were thrombocytopenic with a platelet count of <100K. Sixty-one patients (61/81, 75.3%) with eighty cSDH (80/108, 74.1%) were asymptomatic or mildly symptomatic from the cSDH. MMAE was successfully performed in 104/108 cSDH with PVA particles only (10%), PVA particles and coils (69%), liquid embolic agents (16%), liquid embolic agents and coils (2%) and coils only (3%). At 3-months follow up, 31/108 cSDH (28.7%) demonstrated interval stability (less than 25% increase or reduction in the size of the cSDH) and 48/108 cSDH (44.4%) demonstrated >25% reduction. 29/108 cSDH (26.9%) demonstrated >25% increase in size with 4 cSDH (3.7%) requiring rescue surgery. Two patient experienced asymptomatic acute hemorrhage into the cSDH. No other adverse event was encountered. CONCLUSIONS: cSDH can be safely treated by MMAE in asymptomatic or mildly symptomatic cancer patients with thrombocytopenia or coagulopathy, with 79/108 cSDH (73.1%) demonstrating interval stability or >25% reduction in hematoma size. Only 4 cSDH (3.7%) in 4 patients required rescue surgical evacuation due to hematoma enlargement and development of symptoms. Prospective clinical trial is necessary to compare upfront MMAE vs. observation in this high surgical risk patient population.