Middle Meningeal Artery Embolization Reduces Risk of Incident Dementia Risk Among Patients with Non-acute Subdural Hematoma
Huanwen Chen1, Dhairya Lakhani2, Matthew McIntyre3, Massimo Caulo4, Ajay Malhotra5, Dheeraj Gandhi1, Marco Colasurdo3
1University of Maryland Medical Center, 2West Virginia Unversity, 3Oregon Health and Science University, 4G. D'Annunzio University of Chieti, 5Yale University
Objective:
To determine whether standalone middle meningeal artery embolization (MMAE) is associated with reduced dementia risk compared with conservative management among patients with non-surgical non-acute subdural hematoma (NASDH).
Background:
NASDH is the most common cranial neurosurgical disease that has a predilection for elderly patients, and it is associated with cognitive dysfunction and decline. MMAE has shown efficacy in reducing NASDH recurrence and promoting hematoma resorption, but its potential impact on long-term cognitive outcomes is unexplored.
Design/Methods:
This was a multicenter retrospective cohort study of the TriNetX US collaborative research network. Adult patients with newly-diagnosed NASDH who did not undergo surgical drainage were included. Patients with known dementia at the time of NASDH diagnosis were excluded. Patients who were treated with standalone MMAE were compared to those who received conservative management (CM) only. The primary outcome was new-onset dementia during a three-year study follow-up period. Secondary outcomes included all-cause mortality. One-to-one propensity score matching was performed to account for confounding and indication bias. Outcomes were compared using time-to-event analyses with Kaplan-Meier curves and Cox proportional hazards models.
Results:
Of 177,598 included patients with non-surgical NASDH, 1,294 underwent MMAE. After propensity score matching, 1,281 patients remained in each group with similar baseline characteristics (all absolute standardized differences <0.10). Mean follow-up was 610 days for MMAE patients and 768 days for CM patients. Compared with conservative management, MMAE was associated with significantly lower 3-year probability of incident dementia (5.1% vs 11.5%; P = 0.008; hazard ratio 0.53 [95%CI 0.33-0.86]), representing a 47% reduction in risk. MMAE was also associated with numerically lower all-cause mortality (23.5% vs 31.5%; P = 0.061).
Conclusions:
Standalone MMAE was associated with significantly lower incident dementia risk compared to CM for NASDH patients. These findings suggest MMAE may provide neurocognitive benefits; prospective studies are needed to confirm these observations and establish causality.
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