Comparative Outcomes of Chronic Subdural Hematoma Management: Surgery Combined with Middle Meningeal Artery Embolization vs. Surgery Alone

Muhammad Usman; Maqsood Akram; Waqas Ahmed; Muhammad Junaid; Zahid Hussain; Muhammad Talha Makshoof

doi:10.51253/pafmj.v76iSUPPL-3.13602

Authors

Muhammad Usman Department of Neurosurgery, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Maqsood Akram Department of Neurosurgery, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Waqas Ahmed Department of Neurosurgery, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Muhammad Junaid Department of Neurosurgery, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Zahid Hussain Department of Neurosurgery, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Muhammad Talha Makshoof Department of Neurosurgery, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-3.13602

Keywords:

Chronic Subdural Hematoma, Embolization Middle Meningeal Artery, Mortality, Recurrence

Abstract

Objective: To compare outcomes of middle meningeal artery embolization combined with surgical evacuation versus surgical treatment alone in patients presenting with chronic subdural hematoma in terms of frequency of recurrence and mortality.

Study Design: Quasi experimental study.

Place and Duration of Study: Neurosurgery Department of Combined Military Hospital Rawalpindi, Pakistan and Armed Forces Institute of Radiology and Imaging Rawalpindi, Pakistan from Jun 2022 to Jun 2024

Methodology: Patients with chronic subdural hematoma who underwent treatment in our department were recruited in the study. Patients were divided into two groups: those who received surgical drainage alone (Group-A, 49 patients) and those treated with both surgical drainage and middle meningeal artery embolization (Group-B, 55 patients). Outcome in both the study groups was assessed at the end of six months of procedure in terms of recurrence of hematoma or mortality.

Results: A total of 104 patients were recruited in this study. Out of these, 78 patients were male (75%) while 26 patients were female (25%). Mean age of patients was 54.7±12.1 years. Fifty-five patients (52.9%) underwent middle meningeal artery embolization after surgery while 49 patients (47.1%) underwent surgery alone. Recurrence rate (p=0.006) and mortality (p=0.04) were significantly high in patients who underwent surgery alone (p<0.05).

Conclusion: The addition of middle meningeal artery embolization to conventional surgical evacuation for chronic subdural hematoma significantly reduced the recurrence rate and mortality in our study participants as compared to surgical management alone.

Downloads

Download data is not yet available.

References

1. Buwaider A, Sæmundsson B, Nemer E, Anderberg J, Strom I, Wong SS, et al. Outcomes after standardized burr-hole surgery for chronic subdural hematomas: a population-based consecutive cohort study of 2655 patients. Neurosurg 2025; 97(2): 298-309.

https://doi.org/10.1227/neu.0000000000003320

2. Sadeghian H, Chida K, Motiei-Langroudi R. Editorial: Chronic subdural hematoma: Overview of recent therapeutic advancements. Front Neurol 2023; 14(3): 1155680.

https://doi.org/10.3389/fneur.2023.1155680

3. Sarwar MA, Ali K, Hussain K, Shahid S, UlAbidin Z, Abid M, et al. Management and outcome of chronic subdural hematoma: a prospective study of Shaikh Zayed Hospital, Lahore. Pak J Neurol Surg 2018; 22(1): 24-32.

4. Uno M. Chronic subdural hematoma-evolution of etiology and surgical treatment. Neurol Med Chir 2023; 63(1): 1-8.

https://doi.org/10.2176/jns-nmc.2022-0207

5. Zolnourian A, Manivannan S, Edwards B, Chua A, Arora M, Akhigbe T, et al. Factors affecting outcomes following burr hole drainage of chronic subdural hematoma: a single-center retrospective study. J Neurosurg 2025; 142(6): 1606-1615.

https://doi.org/10.3171/2024.9.JNS24370

6. Papageorgiou NM, Palaiodimou L, Melanis K, Theodorou A, Stefanou MI, Tsalouchidou PE, et al. Embolization of middle meningeal artery in patients with chronic subdural hematoma: a systematic review and meta-analysis of randomized-controlled clinical trials. J Clin Med 2025; 14(9): 2862.

https://doi.org/10.3390/jcm14092862

7. Di Cristofori A, Remida P, Patassini M, Piergallini L, Buonanno R, Bruno R, et al. Middle meningeal artery embolization for chronic subdural hematomas. A systematic review of the literature focused on indications, technical aspects, and future possible perspectives. Surg Neurol Int 2022; 13(3): 94.

https://doi.org/10.25259/SNI_911_2021

8. Sila D, Casnati FL, Vojtková M, Kirsch P, Rath S, Charvát F. Middle meningeal artery embolization versus surgery in patients with chronic subdural hematoma-no more fence sitting? Neurol Int 2023; 15(4): 1480-1488.

https://doi.org/10.3390/neurolint15040096

9. Salih M, Shutran M, Young M, Vega RA, Stippler M, Papavassiliou E, et al. Reduced recurrence of chronic subdural hematomas treated with open surgery followed by middle meningeal artery embolization compared to open surgery alone: a propensity score-matched analysis. J Neurosurg 2022; 139(1): 124-130. https://doi.org/10.3171/2022.11.JNS222024

10. Shamim B, Ashraf AT, Mushtaq MJ, Bhangash KA, Khan AA, Ejaz M. Comparison of one versus two burr hole procedures in evacuation of chronic subdural hematoma. Pak Armed Forces Med J 2024; 74(1): 121-124.

https://doi.org/10.51253/pafmj.v74i1.4002

11. Enriquez-Marulanda A, Gomez-Paz S, Salem MM, Mallick A, Motiei-Langroudi R, Arle JE, et al. Middle meningeal artery embolization versus conventional treatment of chronic subdural hematomas. Neurosurgery 2021; 89(3): 486-495.

https://doi.org/10.1093/neuros/nyab192

12. Ishida T, Inoue T, Inoue T, Saito A, Suzuki S, Uenohara H, et al. Functional outcome in patients with chronic subdural hematoma: postoperative delirium and operative procedure. Neurol Med Chir 2022; 62(4): 171-176.

https://doi.org/10.2176/jns-nmc.2020-0319

13. Hamou HA, Clusmann H, Schulz JB, Wiesmann M, Altiok E, Höllig A et al. Chronic subdural hematoma. Dtsch Arztebl Int 2022; 119(12): 208-213.

https://doi.org/10.3238/arztebl.m2022.0144.

14. Shim YW, Lee WH, Lee KS, Kim ST, Paeng SH, Pyo SY et al. Burr hole drainage versus small craniotomy of chronic subdural hematomas. Korean J Neurotrauma 2019; 15(2): 110-116.

https://doi.org/10.13004/kjnt.2019.15.e25

15. Dinc R. Featured minimally invasive therapeutic approach for chronic subdural hematoma: embolization of middle meningeal artery - A narrative review. Brain Circ 2024; 10(1): 28-34.

https://doi.org/10.4103/bc.bc_65_23

16. Schwarz J, Carnevale JA, Goldberg JL, Ramos AD, Link TW, Knopman J et al. Perioperative prophylactic middle meningeal artery embolization for chronic subdural hematoma: a series of 44 cases. J Neurosurg 2021; 135(6): 1627-1635.

https://doi.org/10.3171/2020.10.JNS202856

17. Onyinzo C, Berlis A, Abel M, Kudernatsch M, Maurer CJ. Efficacy and mid-term outcome of middle meningeal artery embolization with or without burr hole evacuation for chronic subdural hematoma compared with burr hole evacuation alone. J Neurointerv Surg 2022; 14(3): 297-300.

https://doi.org/10.1136/neurintsurg-2021-017450

18. Sattari SA, Yang W, Shahbandi A, Feghali J, Lee RP, Xu R, et al. Middle meningeal artery embolization versus conventional management for patients with chronic subdural hematoma: a systematic review and meta-analysis. Neurosurgery 2023; 92(6): 1142-1154.

https://doi.org/10.1227/neu.0000000000002365

19. Chen H, Salem MM, Colasurdo M, Sioutas GS, Khalife J, Kuybu O, et al. Standalone middle meningeal artery embolization versus middle meningeal artery embolization with concurrent surgical evacuation for chronic subdural hematomas: a multicenter propensity score matched analysis of clinical and radiographic outcomes. J Neurointerv Surg 2024; 16(12): 1313-1319. https://doi.org/10.1136/jnis-2023-020907