Real-World Safety and Efficacy of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Retrospective Cohort Study of 38 049 Patients

BACKGROUND: Chronic subdural hematoma is a complex but commonly treated neurosurgical condition, particularly affecting the elderly. Traditional treatment involves open surgeries, but middle meningeal artery embolization (MMAE) has emerged as an effective, minimally invasive adjunctive. The objective of this study is to assess the safety and efficacy of MMAE in combination with surgery using real-world data. METHODS: This retrospective cohort study analyzed data from the TriNetX Research Network. Outcomes of mortality, reoperation, and hospital readmission were studied using Cox proportional hazard models controlling for age, sex, indications of severity, type of surgical intervention, antiplatelet/anticoagulant use, comorbidities, and hospitalization events. Patients were followed for up to 6 years. RESULTS: This study included 38 049 patients with chronic subdural hematoma, of which 486 received surgery with MMAE and 5362 received surgery monotherapy. At 90 days after surgery, mortality was 5.2% in the MMAE group and 7.7% in the surgery monotherapy group ( P =0.0467). After 6 years, mortality was 11.2% in the MMAE group and 19.0% in the surgery monotherapy group ( P <0.0001). However, the hazard of 90-day mortality was not significantly lower in the MMAE group after controlling for covariates (hazard ratio, 0.739 [95% CI, 0.479–1.141]; P =0.173). Patients with MMAE had significantly lower rates of rehospitalization at 1 year (2.1% versus 4.4%; P =0.0195), even after adjustment (hazard ratio, 0.414 [95% CI, 0.203–0.845]; P =0.015). CONCLUSIONS: Among patients with chronic subdural hematoma who received surgery, patients receiving adjunctive MMAE experienced lower mortality rates out to 6 years of follow-up, but the difference was not significant after full adjustment. Beginning 1 year after surgery, patients receiving combination therapy had significantly lower long-term rehospitalization compared with patients receiving surgery monotherapy. Future prospective studies will help identify strengths and weaknesses of this highly promising treatment modality.