Bilateral middle meningeal artery embolization for the treatment of bilateral chronic subdural hematoma.

Objective: Middle meningeal artery embolization (MMAE) is a treatment strategy increasingly used in the management of chronic subdural hematoma (CSDH). While frequently performed for the treatment of bilateral chronic subdural hematoma (bCSDH), outcomes of bilateral MMAE (bMMAE) have not often been independently reported in the literature. In this study, we document the outcomes and utility of bMMAE for the treatment of bCSDH at our institution.

Methods: This is a retrospective cohort study of patients who underwent bMMAE at our institution between 2018 and 2024. Demographic, clinical, and outcome variables were compared using standard statistical approaches between reoperation and non-reoperation groups, and resolution and non-resolution groups.

Results: Twenty-eight patients underwent bMMAE for the treatment of CSDH. The median age was 75 years. Median radiographic follow-up was 8.0 months. At the time of last-follow-up, radiographic bilateral CSDH resolution was observed in 5 patients (17.9 %) and 10 patients (35.7 %) continued to have symptoms at last follow-up. Reoperation occurred in 5 patients (17.9 %). On univariate comparison between reoperation and non-reoperation cases, patients in the reoperation cohort were more likely to have persistent symptoms at last follow-up (80.0 % versus 26.1 %, p = 0.0410) and had a larger median pre-operative thickness (19.0 versus 13.0, p = 0.0498). There were no significant differences in outcome variables between resolution and non-resolution cases of bMMAE.

Conclusions: bMMAE is a promising technique for the management of bCSDH with and without concomitant surgical evacuation. Further work is required for proper patient identification for bCSDH treatment options.