Middle meningeal artery embolization for chronic subdural hematoma in the nonagenarian population

Justin H Granstein; Thomas B Fodor; Michael Young; Sandeep Muram; Mira Salih; Roberto Garcia; Peter Kan; Philipp Taussky; Christopher S Ogilvy

doi:10.1016/j.clineuro.2025.108747

Middle meningeal artery embolization for chronic subdural hematoma in the nonagenarian population

Clin Neurol Neurosurg. 2025 Jan 17:249:108747. doi: 10.1016/j.clineuro.2025.108747. Online ahead of print.

Authors

Justin H Granstein¹, Thomas B Fodor², Michael Young², Sandeep Muram², Mira Salih², Roberto Garcia³, Peter Kan³, Philipp Taussky², Christopher S Ogilvy²

Affiliations

¹ Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St Suite 3B, Boston, MA 02215, USA; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA. Electronic address: jgranste@bidmc.harvard.edu.
² Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St Suite 3B, Boston, MA 02215, USA.
³ Department of Neurosurgery, University of Texas Medical Branch, 1005 Harborside Dr 5th Floor, Galveston, TX 77555, USA.

PMID: 39837024
DOI: 10.1016/j.clineuro.2025.108747

Abstract

Background: The estimated incidence of chronic subdural hematomas (cSDH) in the general population is projected to nearly double over the next decade, likely making it the most commonly treated cranial neurosurgical condition in adults by 2030. We investigated the outcomes of middle meningeal artery embolization (MMAe) as either a primary or adjunctive treatment for cSDH in nonagenarian patients.

Methods: We retrospectively reviewed all patients 90 years of age or older treated with middle meningeal artery embolization for cSDH from 2018 to 2024 at two academic institutions. Statistical analysis was performed on patient demographics, baseline functional status, intervention, cSDH size, recurrence rate, reintervention rate, and follow-up functional status.

Results: Twenty-one patients aged 90 or older were identified who were treated with MMAe for cSDH. Hematoma thickness ranged from 10mm to 34mm with a mean midline shift of 4.6mm. Eighteen patients were treated with MMAe alone, while three patients underwent surgery followed by MMAe. A total of 20 patients had radiological follow up, with no evidence of growth or recurrence in 95 % of the patients. There was one recurrent cSDH in our cohort in the setting of new trauma after hospital discharge. There was one complication related to the MMAe procedure which was a femoral artery pseudoaneurysm that resolved without further treatment. Median baseline mRS was 3 prior to MMAe and median follow-up mRS after treatment was 2.

Conclusion: MMAe is a safe and efficacious treatment for nonagenarian patients with cSDH, and shows promise as a potential primary treatment modality.

Keywords: middle meningeal artery; nonagenarians; subdural hematoma; therapeutic embolization.