Middle Meningeal Artery Embolization in Adjunction to Surgical Evacuation for Treatment of Subdural Hematomas: A Nationwide Comparison of Outcomes With Isolated Surgical Evacuation

Abstract

BACKGROUND AND OBJECTIVES: Surgical evacuation is the standard treatment for chronic subdural hematomas (CSDHs) but is associated with a high risk of recurrence and readmission. Middle meningeal artery embolization (MMAE) is a novel treatment approach which could be performed upfront or in adjunction to surgical evacuation. MMAE studies are limited by small sample sizes. This study aimed to describe and compare outcomes of MMAE in adjunction to surgery with those of surgery alone on a national level. METHODS: The national Vizient Clinical Database was queried by use of a specific validated set of International Classification of Diseases, Tenth Revision codes (October 2018-June 2022). Patients with the diagnosis of nontraumatic CSDH who received MMAE and surgical drainage in the same hospitalization were identified, and their outcomes were compared with isolated surgical drainage. RESULTS: A total of 606 subjects from 156 institutes and 6340 subjects from 369 institutes were included in the MMAE plus surgery (M&S) and surgery groups, respectively. Average length of stay was significantly longer in the M&S group (9.87 vs 7.53 days; P < .01). There was no significant difference in the in-hospital mortality rate (2.8% vs 2.9%), but the complication rate was significantly higher in the M&S group (8.7% vs 5.5%; P < .01). Complications that were significantly more common in the M&S group included aspiration pneumonia, postoperative sepsis, and anesthesia-related. Mean direct costs were significantly higher in the M&S group (28 834 vs 16 292 US dollars; P < .01). The 30-day readmission rate was significantly lower in the M&S group compared with the surgery group (4.2% vs 8.0%; P < .01). CONCLUSION: This analysis of large-scale national data indicates that MMAE performed in adjunction to surgery for treatment of CSDH is associated with higher direct costs, higher complication rates, and longer length of stay but lower readmission rates compared with surgical evacuation alone.

Letter: Middle Meningeal Artery Embolization in Adjunction to Surgical Evacuation for Treatment of Subdural Hematomas: A Nationwide Comparison of Outcomes With Isolated Surgical Evacuation

“…We read with great interest the article by Dr Khorasanizadeh et al 1 from the June 2023 issue of neurosurgery. According to the findings of the authors' study, in comparison with surgical evacuation alone, middle meningeal artery embolization (MMAE), which is used in addition to surgery to treat chronic subdural hematoma (CSDH), is associated with higher direct costs, higher complication rates, and longer lengths of stay.…”

Letter: Middle Meningeal Artery Embolization in Adjunction to Surgical Evacuation for Treatment of Subdural Hematomas: A Nationwide Comparison of Outcomes With Isolated Surgical Evacuation

“…We thank Khorasanizadeh et al 1 for their significant efforts in using the data from the National Vizient Clinical Database from 2018 to 2022 to summarize the evolution in outcomes of middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH). The article is of great interest to the vascular and endovascular neurosurgery.…”

In Reply: Middle Meningeal Artery Embolization in Adjunction to Surgical Evacuation for Treatment of Subdural Hematomas: A Nationwide Comparison of Outcomes With Isolated Surgical Evacuation

“…We appreciate Essibayi et al for their commentary 1 on our recent study titled "Middle Meningeal Artery Embolization in Adjunction to Surgical Evacuation for Treatment of Subdural Hematomas: A Nationwide Comparison of Outcomes with Isolated Surgical Evacuation." 2 In the latter article, we evaluated the efficacy of middle meningeal embolization (MMAE) as adjunctive treatment to surgery (S) in patients with chronic subdural hematoma (CSDH) and compared different outcomes with isolated surgical treatment. This study was conducted on a large sample using aggregate data retrieved from the National Vizient Clinical Database from 2018 to 2022.…”

“…We appreciate Essibayi et al for their commentary 1 on our recent study titled “Middle Meningeal Artery Embolization in Adjunction to Surgical Evacuation for Treatment of Subdural Hematomas: A Nationwide Comparison of Outcomes with Isolated Surgical Evacuation.” 2…”