ABSTRACT
Objectives: MMA embolization has emerged in recent years as a safe and minimally invasive treatment for a chronic subdural haematoma. We report the first UK series of endovascular treatments of chronic subdural haematomas. Design: Prospective case series. Subjects: All adult patients referred with minimal midline shift (≤8 mm) and GCS ≥14/15 were considered. Patients had to be mobile with a standard origin of Middle Meningeal and Ophthalmic arteries. Patients with GCS ≤13 or profound weakness (MRC grade ≤3) were treated with Burr hole drainage and placement of subdural drains. Methods: Patients were recruited over a 7-month period from 25/10/2020 to 25/05/2021 through our electronic referral system. Patients' demographics, pre-morbid modified Rankin Score (mRS), symptoms, anticoagulation, and co-morbidities were prospectively collected. Suitability for endovascular treatment was discussed with the Neurovascular radiologist and neurosurgeon. SQUID-12 embolic material was used for all MMA embolizations which were performed under General Anaesthetic. Baseline CT/MRI characteristics were collected. Further imaging was obtained at 7, 21, 90, and 180 days. Clinical assessment and mRS were completed at three months. Results: Ten patients underwent endovascular embolization of MMA in the study period. Of these eight were male, the median age was 79 years. The median length of stay was 3 days. Follow-up CT at 3 weeks, obtained for 6/10 patients, has demonstrated significant reduction in both midline shift (μ = 3.3 mm, p = 0.0019) and maximum thickness of haematoma (μ = 5.8 mm, p = 0.0055). At the time of submission, five patients had reached the three months' follow-up period, of which, three had a complete radiological resolution, with a further patient observed to have >50% improvement in CT parameters. We report one mortality due to COVID-19. Conclusions: For select patients, MMA embolization is a safe, minimally invasive, and effective treatment for a chronic subdural haematoma. As we gain more experience, the procedure could be performed under local anaesthetic.