Single-session middle meningeal artery embolization and surgical evacuation for chronic subdural hematoma

Background The aim of this study was to evaluate the preliminary experience of a combined middle meningeal artery embolization (MMAE) and burr hole evacuation approach for chronic subdural hematoma (cSDH) under a single anesthesia session. Methods We performed a retrospective review of all patients who underwent MMAE and burr hole surgery during the same admission at a single major academic institution between 2019 and 2024. Patients were dichotomized by those with both procedures performed under a single anesthesia session (combined) or two separate sessions (separate). Baseline demographics, comorbidities, and complications were compared. The primary outcomes were in-hospital and 90-day complication and reoperation rates. Results 103 patients were included in the study (median age 74 (67–81) years), with 33.9% in the combined cohort. Demographics, comorbidities, and radiographic characteristics were similar between the cohorts. While cumulative procedure times were similar (separate 85 (71–110) min vs combined 96 (82–127) min), total anesthesia time was significantly longer for patients with separate procedures (separate 225 (193–264) min vs combined 165 (145–183) min, P<0.001). There were no differences in the rates of access site complications, reoperation, stroke, or mortality between the cohorts. The combined cohort trended to have shorter length of stay (separate 6 (5–8) days vs combined 5 (4–7) days, P=0.058). There were no differences in complication or reoperation rates within 90 days. Conclusion The results of this study suggest that MMAE performed under a single anesthesia session with burr hole evacuation surgery is a safe and potentially resource-efficient approach for the management of cSDH.