287 Middle Meningeal Artery Embolization for Chronic Subdural Hematoma in Cancer Patients: A Propensity-Matched Cohort Study

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INTRODUCTION: Chronic subdural hematoma (cSDH) management in cancer patients is challenging due to altered coagulation and bleeding risk. Middle meningeal artery embolization (MMAE) efficacy in this population remains unclear. METHODS: We conducted a retrospective cohort study using the TriNetX Analytics Network, analyzing patients aged ≥18 years with cSDH and concurrent cancer diagnoses from inception to May 2025. Patients underwent either MMAE or standard care without MMAE. Propensity score matching (1:1) was performed to balance baseline characteristics. Primary outcomes included all-cause mortality, cSDH recurrence, and reintervention rates at 6, 12, 24, and 60 months. Secondary outcomes encompassed hematoma resolution, hospital readmission, and complications. RESULTS: From 37,966 patients with cSDH and cancer, 311 underwent MMAE and 37,655 received standard care. After 1:1 propensity matching, 250 matched pairs were analyzed with well-balanced baseline characteristics. At 6 months, MMAE demonstrated significantly reduced cSDH recurrence (6.4% vs 14.8%; RR 0.43, 95% CI 0.25-0.75, p = 0.002) and reintervention rates (5.6% vs 12.4%; RR 0.45, 95% CI 0.25-0.83, p = 0.01). All-cause mortality showed no significant difference (15.6% vs 19.6%; RR 0.80, p = 0.25). At 60 months, recurrence remained lower (10.8% vs 18.8%; RR 0.57, p = 0.01) and reintervention reduced (9.2% vs 19.6%; RR 0.47, p = 0.001). Subgroup analyses showed consistent recurrence reduction in solid tumors (RR 0.42, p = 0.01), patients <75 years (RR 0.44, p = 0.04), and ≥75 years (RR 0.42, p = 0.03). Adverse events were similar between groups (stroke: 2.4% vs 1.2%, p = 0.32). CONCLUSIONS: MMAE significantly reduces cSDH recurrence and reintervention rates in cancer patients without compromising safety, supporting its use in this high-risk population.

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