361 Enhanced Recovery After Middle Meningeal Artery Embolization: Safety of Same-Day Discharge

INTRODUCTION: Middle Meningeal Artery Embolization (MMAE) has emerged as a promising adjunct or standalone endovascular treatment for chronic subdural hematomas (cSDH). Evidence suggests that MMAE may yield equal or superior outcomes to surgical evacuation in terms of complications, cost-effectiveness, and length of hospital stay. METHODS: A retrospective review was performed of patients with same-day discharge following MMAE from September 2022 to February 2024. Variables including embolic material used, access site, postoperative imaging, and any reported readmissions or complications were collected. RESULTS: Eight patients were included in the study with 9 transradial MMAE for cSDH. Six procedures were primary MMAE, 3 procedures were adjunctive MMAE for residual cSDH after previous surgical evacuation. One patient was treated with Onyx-18 (12.5%), 1 patient with coils (12.5%), and 6 patients with Polyvinyl Alcohol Particles (PVA) and coils (75%). One patient had an intraoperative CT head scan that was without significant findings, otherwise the other 7 patients did not undergo postoperative imaging. All patients (100%) had preoperative and postoperative intact neurological exams, discharged home in good condition after recovery in the post anesthesia care unit. One patient had MMAE with general anesthesia, while the other 7 patients tolerated the procedure well with moderate sedation and local anesthesia. There were no re-admissions in our cohort. On follow-up, after an average of 1.5 months, 6 (75%) patients had complete resolution of their SDH, 1 (12.5%) patient had a stable size cSDH, and 1 (12.5%) patient had a decrease in their cSDH size. CONCLUSIONS: Our pilot study demonstrates the safety of same-day discharge as part of enhanced recovery following uncomplicated MMAE for patients with intact neurological exams using the transradial route. Further research is warranted to assess long-term efficacy and patient selection.