Abstract No. 223 A Comparison of Middle Meningeal Artery Embolization and Open Approach for the Treatment of Chronic Subdural Hematoma

The purpose of this research is to compare middle meningeal artery embolization to an open craniotomy approach for the treatment of chronic subdural hematoma. TriNetX, a global federated research database network, was used for this study. This database contains de-identified patient information on over 213 million patients in 92 large healthcare organizations. Two patient cohorts were created for this study. Both groups consisted of patients who were 18 or older and had a diagnosis of nontraumatic chronic subdural hemorrhage as identified by their International Classification of Disease (ICD-10) codes, I62.03 and I62.00. Patients were excluded if they had a previous diagnosis of arteriovenous malformation (Q28.2), malignant neoplasm of the brain or other unspecified site (C71, C76), epistaxis (R04.0), cerebral aneurysm (I67.1). One cohort consisted of patients who received middle meningeal artery embolization (61624, 61626) and the other cohort consisted of patients who received an open approach for evacuation of the subdural hematoma (00C40ZZ). Both groups were matched for age, sex, race, type 2 diabetes mellitus, essential hypertension, chronic kidney disease, nicotine dependence, obesity, and ischemic heart disease. They were then measured for the outcome of the recurrence of subdural hemorrhage, the need for burr holes, or the need for craniectomy or craniotomy between seven and 180 days after the initial procedure. A total of 464 patients, with 232 patients in each arm were included in the final analysis. Patients who initially received the open approach for treatment were found to have a 16% reduced risk of developing a rebleed or needing further intervention with burr holes or another craniotomy ([RR] 0.84, 95% CI 0.72-0.99, P=0.03). Middle meningeal artery embolization in previous studies and individual case reports showed a promising alternative to the open approach in the treatment of chronic subdural hematomas and possibly a preferred route of treatment. However, the current study does not support this idea and demonstrates that middle meningeal artery embolization alone may have an increased risk of developing recurrent bleeds needing further intervention. Further investigation is needed to determine whether middle meningeal artery embolization in conjunction with an open approach for the treatment of chronic subdural hematomas would improve results.