Abstract Number ‐ 39: Comparison of Clinical and Radiographic Efficacy of Particles versus nBCA/Onyx in MMA Embolization for cSDH

Abstract

Introduction Middle meningeal artery (MMA) embolization has emerged as a minimally invasive alternative to open surgery for treatment of chronic subdural hematoma (cSDH). Different embolic materials are utilized in this procedure per operators’ discretion; however, limited data currently exists regarding the clinical and radiographic efficacy of these embolic materials, with available studies lumping Onyx and N‐Butyl cyanoacrylate (n‐BCA) into a single group of liquid embolic material. Methods Series of consecutive patients undergoing MMA embolization (MMAE) for cSDH at 2 North American centers (2019‐2021) were included. The primary outcomes included cSDH radiographic resolution of cSDH with at least 50% reduction of hematoma thickness to be considered treatment success. Clinical outcomes were defined as the proportion of patients requiring additional unplanned surgical intervention. These outcomes compared between the particles group, the liquid group which were further subdivided into the n‐BCA and Onyx groups. Results Overall, 185 patients undergoing 198 MMAE procedures (median age 72 years, 27.5% women) were included in this analysis. In this cohort, 42.6% of the procedures were performed utilizing particles embolic material, while n‐BCA and Onyx were utilized in 29.5% and 26.8% of procedures, respectively. On last follow‐up imaging (median 3.5 months), ≥ 50% reduction in hematoma thickness was achieved in 67.7%, 71.1%, and 72.3% in the particles, Onyx and the n‐BCA group, respectively (p = 0.2). There were no differences in the proportion of patients requiring additional unplanned surgery between the groups (p = 0.6). Similarly, there was no difference in procedural complications between the 3 embolic materials groups. Conclusions MMAE for cSDH utilizing particles and liquid embolic materials (including Onyx and n‐BCA) appears to have an overall equivalent safety and efficacy profiles in cSDH treatment. Further studies with larger sample sizes and longer follow‐up are warranted.