Effectiveness of subdural evacuating port system (SEPS) and middle meningeal artery embolization (MMAE) for chronic subdural hematomas

BackgroundPerforming a craniotomy for chronic subdural hematoma (cSDH) in elderly patients with comorbidities can be challenging. The Subdural Evacuating Port System (SEPS; Medtronic, Dublin, Ireland) offers a less-invasive alternative, while middle meningeal artery embolization (MMAE) has shown effectiveness in preventing cSDH recurrence. However, the combined effectiveness of SEPS and MMAE (SEPS + MMAE) remains unclear. This study reports the outcomes of patients undergoing a combination of these procedures for the treatment of cSDH.MethodsA retrospective review of our medical records database was conducted to identify patients with cSDH who were treated with SEPS + MMAE between January 1, 2021, and April 1, 2024. Demographics, comorbidities, procedure, and outcomes data were analyzed. cSDH resolution was tracked by measuring hematoma volumes on noncontrast computed tomography scans pre-SEPS + MMAE, 24-48 h postprocedure, and 6-8 weeks postprocedure.ResultsA total of 35 patients (median age: 77 years [interquartile range (IQR):69-85.5]; men:woman = 22:13) with 49 cSDH, of which 41 cSDHs receiving combined SEPS + MMAE were included. Notably, 38 (92.7%) of the 41 cSDHs were holohemispheric, and 15 (36.6%) had an acute or subacute component. The median pre-SEPS + MMAE cSDH volume was 121.9 mL [IQR:87.9-153.4 mL] with a median midline shift of 6.6 mm [IQR:3.5-10 mm]. All MMAE procedures were performed under conscious sedation. The femoral approach was utilized in 19 patients (54.3%). Three patients required rescue craniotomy. Median post-SPES + MMAE volume was 71.1 mL [IQR:54.5-93.2], resulting in a 38% [IQR:21.9-53] reduction in cSDH volume; and median follow-up SEPS + MMAE volume was 22 mL [IQR:2-59.2] resulting in an 81% [IQR:50.9-98.1] reduction in cSDH volume, compared to pre-SEPS + MMAE levels. Seven (17.1%) patients required readmission for residual or recurrent cSDH within 90 days. Five of these patients were retreated (12.2%), two of whom required craniotomy (4.9%).ConclusionOur experience suggests that SEPS + MMAE was an effective method of cSDH treatment and was associated with low complication rates.