Single-session combined middle meningeal artery embolization and hematoma evacuation versus staged approaches in symptomatic chronic subdural hematoma treatment: A single-center experience.

BACKGROUND Middle meningeal artery (MMA) embolization can serve as an adjunct to prevent recurrent subdural hematoma. Hybrid operating rooms (ORs) with biplane neuroangiography now allow MMA embolization and cSDH drainage to be performed in a single stage. This study compares this single-stage approach with the traditional staged workflow, where patients undergo cSDH drainage in a neurosurgical OR followed by delayed MMA embolization in a separate neuroangiography suite.

METHODS Clinical data were extracted for 51 patients who underwent both cSDH drainage and MMA embolization at our center. Demographic information and surgically relevant parameters were compared between patients treated with a single-stage approach and those treated with a staged approach to identify differences beyond the timing of the procedures. The primary outcome was radiographic improvement following treatment, defined by reduction in hematoma thickness and midline shift. Secondary outcomes included total procedure room time, anesthesia duration, and operative duration.

RESULTS No significant differences were identified in the demographic characteristics of patients undergoing the single-stage or two-stage approach. Baseline cSDH characteristics, as well as operation-relevant parameters, were comparable between the two groups. Postoperative midline shift and reduction in hematoma thickness improved and were comparable between groups. Total procedure room time, anesthesia duration, and operative duration were also similar.

CONCLUSION Results from this study suggest that single-stage MMA embolization procedures performed in hybrid ORs may not always be more efficient than the two-stage approach. Further research is needed to comprehensively evaluate the optimal timing and approach for patients undergoing MMA embolization procedures for cSDH management.