Comparative study between surgical drainage alone and adjuvant middle meningeal artery embolization with Histoacryl for the treatment and prevention of chronic subdural hematoma recurrence.

INTRODUCTION

The management of chronic subdural hematoma (CSDH) faces a high recurrence rate. Cohort studies have demonstrated a reduction in recurrence with middle meningeal artery embolization (MMAE). This study aims to demonstrate that this therapy is a safe and effective treatment and that, when combined with surgical drainage, it is superior to surgical treatment alone in reducing the recurrence rate.

METHODS

This is a single-center, prospective, randomized study designed to evaluate the superiority of surgery followed by MMAE in reducing the recurrence rate of CSDH compared to surgery alone. A total of 76 hematomas were randomized in a 1:1 ratio to receive surgery followed by MMAE or conventional surgical treatment, with 69 patients evaluated at the end of the study. The primary outcome assessed was the recurrence rate of these hematomas within 90 days post-randomization.

RESULTS

A total of 76 chronic subdural hematomas were included in this study, with 43 randomized to the control group and 33 to the intervention group. Hematoma recurrence within 90 days occurred in 1 patient (4.2%) in the intervention group compared to 4 patients (12.5%) in the control group (Absolute Risk Reduction, 8.3%; p = 0.379). The 90-day mortality rate was 6.1% in the intervention group and 11.6% in the control group (p = 0.434). No differences were observed in hospitalization duration or severe complication rates.

CONCLUSIONS

In symptomatic patients who underwent surgical treatment for CSDH drainage, the addition of MMA embolization showed a trend toward reducing the recurrence rate and 90-day mortality.