Middle Meningeal Artery Embolization for Chronic Subdural Hematoma in Cancer Patients: A Propensity-Matched Cohort Study of 90-Day Outcomes.

BACKGROUND

Cancer patients with chronic subdural hematoma (cSDH) face higher recurrence and surgical risk. Middle meningeal artery embolization (MMAE) has emerged as a minimally invasive treatment for cSDH, but evidence is limited as cancer patients are mostly excluded from trials.

METHODS

Using the TriNetX US Collaborative Network, we identified adults with nontraumatic cSDH and a neoplasm diagnosed within one year before the index event. We performed four 1:1 propensity-score-matched comparisons: MMAE versus medical management and surgery plus MMAE versus surgery alone (both within cancer patients), and cancer versus no cancer within the medically managed and surgical cohorts. Outcomes were 90-day all-cause mortality and rescue surgery, assessed with Kaplan-Meier estimates and Cox proportional-hazards models.

RESULTS

Among cancer patients, MMAE versus medical management (694 matched pairs) was associated with lower 90-day mortality (15.3% vs 20.9%; HR 0.69, 95% CI 0.53-0.89; p=0.004), with no significant difference in rescue surgery (6.8% vs 4.5%; p=0.10). Adding MMAE to surgery (355 pairs) was associated with fewer rescue operations (8.8% vs 13.7%; HR 0.63, 95% CI 0.40-0.99; p=0.04) and numerically lower mortality (10.4% vs 13.4%; p=0.19). Cancer was associated with higher mortality among medically managed patients (18.5% vs 15.8%; p<0.001) and higher rescue surgery among surgical patients (14.9% vs 11.4%; p<0.001).

CONCLUSION

MMAE was associated with a lower need for repeat surgical intervention in cancer patients with cSDH without raising mortality or complications. It is a safe, minimally invasive alternative to repeated surgical drainage for this high-risk group.