Management of Chronic Subdural Hematoma; Middle Meningeal Artery Embolization versus Surgical Evacuation: A Comparative Study

Mohamed Shehab Saad Zaghloul; Farouk Mustafa; Mohamed Ahmed Gabr; Ahmed Ezzat; Fathullah Haroon

doi:10.64516/bse6sn42

Authors

Mohamed Shehab Saad Zaghloul Department of Neurosurgery, Faculty of Medicine, Cairo University, Egypt Author
Farouk Hassan Youssef Mustafa Department of Radiodiagnosis, Faculty of Medicine, Cairo University, Egypt Author
Mohamed Ahmed Gabr Department of Neurosurgery, Faculty of Medicine, Cairo University, Egypt. Author
Ahmed Adel Mohamed Ezzat Department of Neurosurgery, Faculty of Medicine, Cairo University, Egypt. Author
Fathullah Saad Haroon Department of Neurosurgery, Faculty of Medicine, Tobruk University, Libya. Author

DOI:

https://doi.org/10.64516/bse6sn42

Keywords:

Chronic Subdural Hematoma, Middle Meningeal Artery Embolization, Surgical Evacuation

Abstract

Background: Chronic subdural hematoma (CSDH) is a prevalent neurosurgical pathology greatly impacting elderly cases and is correlated to significant morbidity and death

Aim: This study aimed to compare the clinical and radiological results between surgical evacuation and middle meningeal artery embolization in the management of chronic subdural hematoma.

Material and Methods: This was a prospective, non-randomized case series clinical trial study that was conducted on symptomatic chronic subdural patients who were admitted to Cairo University Hospitals starting from October 2022 to October 2023.

Results: All patients experienced postoperative headache relief, with immediate improvement in Group A and delayed improvement from the second month in Group B. Motor power also improved immediately in Group A, while Group B showed improvement starting from the second month. According to the Markwalder grading system, Group A showed non-significant improvement (p = 0.082), with most patients initially at grade 1, while all Group B patients were grade 1 on admission. The average postoperative hospital stay was significantly shorter in Group B (2.5 ± 1.0 days) in comparison with Group A (5.20 ± 4.31 days), reducing infection risk; this variance was highly statistically significant (p < 0.001).

Conclusion: Surgical evacuation offers immediate symptom relief and reduced hematoma thickness, while long-term clinical and radiological outcomes are comparable to surgery and MMA embolization. MMA embolization is less invasive, lower-risk, and quicker, but requires close monitoring and is effective in carefully selected non-acute cases.

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