The New England Journal of MedicineAdjunctive Middle Meningeal Artery Embolization for Subdural Hematoma

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Middle meningeal artery (MMA) embolization combined with surgical evacuation showed promising results in reducing reoperation rates for subdural hematoma patients, according to a multicenter trial of 400 participants. The study provides new evidence for a potential adjunctive treatment option in managing this common neurosurgical condition.

Study Design:

• Prospective, multicenter, interventional, adaptive-design trial with 400 participants (197 treatment, 203 control)
• Compared MMA embolization plus surgery vs. surgery alone for symptomatic subacute/chronic subdural hematoma
• Primary endpoint: hematoma recurrence/progression requiring reoperation within 90 days
• Secondary endpoint: neurologic function deterioration at 90 days (modified Rankin scale)
• 34% of surgeries occurred before randomization

Key Findings:

• Reoperation rates: 4.1% (treatment) vs. 11.3% (control); relative risk 0.36 (95% CI: 0.11-0.80, P=0.008)
• Functional deterioration: 11.9% (treatment) vs. 9.8% (control)
• 90-day mortality: 5.1% (treatment) vs. 3.0% (control)
• Serious adverse events from embolization: 2.0% by 30 days, including 2 cases of disabling stroke
• No additional adverse events reported between 30-180 days

HCN Medical Memo
Although MMA embolization shows promise in reducing reoperation rates, the increased risk of functional deterioration and mortality warrants careful patient selection. Consider this approach for patients at high risk of recurrence who can tolerate potential procedural complications.

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