Neurosurgery Resident University of Pittsburgh Medical Center
Introduction: Evidence supporting middle meningeal artery embolization (MMAE) as a treatment for chronic subdural hematoma (cSDH) is expanding, yet there is limited data comparing different liquid embolic materials. This study aimed to compare the efficacy and safety of Onyx and n‐Butyl cyanoacrylate (n‐BCA) in MMAE for cSDH.
Methods: All patients who underwent MMAE for cSDH at a single institution between April 2019 and December 2022. Primary outcomes were treatment success (defined as a ≥50% reduction in hematoma thickness on radiographic imaging) and the need for rescue surgical intervention. Secondary outcomes included complication rates and hematoma thickness at the last available follow-up.
Results: A total of 195 patients (234 cases, including 39 bilateral hematomas) underwent MMAE. Onyx was used in 71.8% (n=168) and n-BCA in 28.2% (n=66) of cases. Radiographic resolution was achieved in 50.9% of cases with Onyx and 54.8% with n-BCA (aOR1.49; 95% CI: 0.78-2.85; p = 0.22). The need for rescue surgical intervention was 4.8% for Onyx and 7.6% for n-BCA (aOR 1.82; 95% CI: 0.53-6.23; p = 0.33). Median subdural hematoma thickness at the last follow-up was 8.25 mm for Onyx and 6.9 mm for n-BCA (p = 0.11) and complication rates were 1.2% for Onyx and 1.5% for n-BCA (p = 0.84). Sensitivity analysis, excluding patients with concurrent surgical intervention, showed similar results for radiographic resolution (aOR: 1.35; 95% CI: 0.65-2.76; p = 0.42) and the need for rescue surgical intervention (aOR: 2.35; 95% CI: 0.62-8.84; p = 0.21).
Conclusion : Onyx and n‐BCA appear to have comparable outcomes for MMAE in the treatment of cSDH. Further prospective studies with larger sample sizes are warranted to confirm these findings.
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