Embolization of Middle Meningeal Arteries for Symptomatic Subacute Subdural Hematoma in Patients with Cancer.

PURPOSE: The purpose of this study was to evaluate the technical and clinical success of middle meningeal artery (MMA) embolization performed for symptomatic subacute subdural hematoma (SDH) in patients with cancer.

METHODS: This study retrospectively included 23 consecutive patients (12 men, 11 women; median age 61 years, interquartile range: 55.5-75.5) who underwent 34 MMA angiograms for symptomatic SDH in 2022 and 2023. Median SDH thickness was 10.5 mm (7-12). Median platelet count was 117 K/mcL (54.5-218). 10 patients (43.5%, 10/23) had hematologic malignancies, seven patients (30.4%, 7/23) had surgery. Fluoroscopy time (FT), reference dose (RD), and kerma area product (Kap) were analyzed. Adverse events and outcomes were recorded.

RESULTS: The median imaging and clinical follow-up were 65 days (36.5-190.5) and 163 days (86-274), respectively. The technical success rate was 91.2% (31/34) as three MMA were not identified in two patients. Median procedure duration was 61 min (55.5-75.5). Median FT was 21.6 min (15.5-31.8); median RD was 158 mGy (96-256); and median Kap was 32.9 Gy.cm2 (20.4-45.1). No further intervention was needed. For 16 patients, SDH resolved after in median 59.5 days (50-90). For seven patients, SDH remained visible on the last imaging follow-up performed at 24 days in median (6.5-36.5). No predictive factor of failure was identified. The adverse event rate was 1/23 (4.3%). Eight patients (34.8%, 8/23) died during follow-up from progression of cancer.

CONCLUSION: MMA embolization of symptomatic SDH in patients with cancer appears safe and is associated with improvement in clinical symptoms.