Effect of early versus delayed middle meningeal artery embolization on clinical outcomes in chronic subdural hematoma: A propensity score-matched cohort study

Background: Chronic subdural hematoma (cSDH) is a common neurosurgical condition with a high recurrence rate following surgical evacuation. Middle meningeal artery embolization (MMAE) has emerged as an adjunctive or standalone treatment, but the optimal timing of embolization remains unclear. We evaluated whether early MMAE (≤2 days) versus delayed MMAE (3–7 days) is associated with improved clinical outcomes. Methods: In this retrospective, multicenter cohort study, we identified adult patients with cSDH who underwent MMAE using de-identified real-world patient data from the TriNetX platform. Patients were stratified into early versus delayed MMAE groups, defined relative to the date of surgery (surgical cohort) or diagnosis (non-surgical cohort). Propensity score matching (1:1) was performed based on demographics and comorbidities. The primary outcome was all-cause mortality and secondary outcomes included repeat surgical evacuation (for surgical cohort) and need for surgical evacuation (for non-surgical cohort) at 6-months. Results: In the matched surgical cohort (n = 326), early MMAE was associated with a lower, but not statistically significant, rate of mortality compared to delayed MMAE (6.1 % vs. 11.0 %; OR, 0.527; 95 % CI, 0.235–1.178; P = 0.114). Similar rates were observed for repeat surgery for both groups. In the matched non-surgical cohort (n = 450), early MMAE was not associated with significant differences in mortality or need for surgery. Conclusions: Among patients with cSDH, early MMAE was associated with numerically lower rates of mortality in the surgical cohort. These findings support further investigation of early MMAE as a potential strategy to improve outcomes in surgical cSDH cases.