A97 Combined treatment of chronic subdural hematoma: a preliminary experience after institutional protocol implementation

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Background/Introduction Middle meningeal artery embolization (MMAe) has shown promising results for the treatment of chronic subdural hematoma (CSDH), both as an adjunct to surgery or as stand alone in selective cases. A pragmatic adaptation of trial results into an evidence-based institutional protocol and definition of a collaborative workflow to individualised treatment is needed. Objective/Purpose To assess clinical and radiological outcomes of patients with CSDH after institutional implementation of a protocol for MMAe in a tertiary European centre. Methods/Case Description Consecutive series (n = 35) of patients with CSDH treated with MMAe as single or combined treatment with burr hole evacuation. Primary radiological outcomes were hematoma diameter at 1 and 6 months; primary clinical outcomes were modified Rankin Scale (mRS) at 1 and 6 months. Results/Findings 35 patients were treated according to the new protocol between November 2023 and January 2025. Standalone MMAe was indicated for pauci-symptomatic patients and diameter >10mm. MMAe was combined with burr hole in symptomatic patients and high risk of recurrence, as one- or two-stage procedure. After protocol implementation, the annual number of cases increased exponentially. Most (51%) were treated with MMAe alone. Most frequent complication was MMAe rupture (24%), without clinical implications. At 6 months, complete or near complete (<5mm) resolution was achieved in 90%. Two patients (6%) required rescue surgery. At 6 months, 80% of patients had an independent functional status (mRS 0-2). Discussion/Conclusions/Learning Points Real-life implementation of MMAe into an evidence-based institutional protocol seems to provide favourable outcomes, both radiologically and clinically.

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