{
  "abstract": "Introduction/Purpose Middle meningeal artery embolization (MMAE) has emerged as an effective treatment for subdural hematomas (SDH), yet predictors of radiographic and clinical outcomes remain incompletely understood. While prior studies have evaluated hematoma size broadly, the impact of very large SDHs (VL-SDH; thickness ≥ 20 mm) on outcomes following MMAE is not well defined. This study aimed to compare radiographic evolution and clinical outcomes between VL-SDH and non-VL SDH following MMAE.Materials and Methods We performed a retrospective review of patients undergoing MMAE for SDH at a single institution between 2021 and 2023. Hematomas were categorized as VL-SDH (≥ 20 mm) or non-VL SDH (< 20mm) according to baseline thickness at presentation. Bilateral hematomas were analyzed as independent observations where applicable. Baseline demographics, procedural characteristics, and outcomes were compared between groups. Radiographic outcomes included percent change in SDH thickness at multiple follow-up intervals and rates of resolution. Clinical outcomes included mortality, complications, readmission, and need for surgical evacuation. Multivariable logistic regression was used to evaluate the association between VL status and outcomes, adjusting for relevant covariates.Results A total of 170 patients (233 hematomas) were included, with 52 VL-SDHs and 118 non-VL SDHs. Patients with VL-SDH were slightly older (median 79 vs 76 years, p<.05) and had greater baseline midline shift (6.25 mm vs 0.00 mm, p <.001). VL-SDHs were more likely to undergo concurrent surgical decompression (71.2% vs 14.4%, p<.001). VL-SDHs demonstrated significantly greater early reductions in thickness at 1-4 weeks (-45.01% vs -18.94%, p<.001), 1-3 months (-67.95% vs 52.91%, p<.05), and 3-6 months (-77.42% vs -63.19%, p<.05). Differences at later time points were not statistically significant. Importantly, final radiographic outcomes were similar between groups. Rates of complete resolution did not differ (43.4% vs 45.2%, p>.05), and VL-SDH was not significantly associated with resolution on multivariable analysis (OR 1.189, 95% CI 0.35-3.9, p>.05). Additionally, there were no significant differences in need for post-discharge surgical evacuation, mortality, or complication rates. Conclusion:Despite greater initial size and mass effect, VL-SDHs demonstrate similar ultimate resolution and clinical outcomes compared to smaller hematomas following MMAE. While early radiographic improvement is more pronounced in VL-SDHs, this is likely driven by higher rates of concurrent surgical decompression rather than embolization alone. Hematoma thickness alone does not appear to be a strong predictor of procedure complexity or outcomes, supporting the use of MMAE across a broad spectrum of SDH sizes and reinforcing its potential role even in very large hematomas.Disclosures E.M. Kunz: None. H. Cherian: None. L. Zhou: None. R. Ahuja: None. A. Durrani: None. S. Fanilla: None. A. McNally: None. A. Navarro: None. S. Sanjeev: None. R. Solorzano: None. P. Kumar: None. M. Fakhar: None. N. Mahmoud: None. A. Saxena: None. S. Rahman Chowdhury: None. M. McDermott: None. I. Linfante: None. G. Dabus: None. R. Wicks: None.",
  "authors": [
    {
      "affiliations": [
        "Florida International University Herbert Wertheim College of Medicine, Miami, FL"
      ],
      "name": "EM Kunz"
    },
    {
      "affiliations": [
        "Florida International University Herbert Wertheim College of Medicine, Miami, FL"
      ],
      "name": "H Cherian"
    },
    {
      "affiliations": [
        "Baptist Health South Florida, Miami, FL"
      ],
      "name": "L Zhou"
    },
    {
      "affiliations": [
        "Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL"
      ],
      "name": "KM Hassan"
    },
    {
      "affiliations": [
        "Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL"
      ],
      "name": "R Ahuja"
    },
    {
      "affiliations": [
        "Florida International University Herbert Wertheim College of Medicine, Miami, FL"
      ],
      "name": "A Durrani"
    },
    {
      "affiliations": [
        "Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL"
      ],
      "name": "S Fanilla"
    },
    {
      "affiliations": [
        "Florida International University Herbert Wertheim College of Medicine, Miami, FL"
      ],
      "name": "A McNally"
    },
    {
      "affiliations": [
        "Florida International University Herbert Wertheim College of Medicine, Miami, FL"
      ],
      "name": "A Navarro"
    },
    {
      "affiliations": [
        "Florida International University Herbert Wertheim College of Medicine, Miami, FL"
      ],
      "name": "S Sanjeev"
    },
    {
      "affiliations": [
        "Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL"
      ],
      "name": "R Solorzano"
    },
    {
      "affiliations": [
        "Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL"
      ],
      "name": "P Kumar"
    },
    {
      "affiliations": [
        "Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL"
      ],
      "name": "M Fakhar"
    },
    {
      "affiliations": [
        "Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL"
      ],
      "name": "N Mahmoud"
    },
    {
      "affiliations": [
        "Baptist Health South Florida, Miami, FL"
      ],
      "name": "A Saxena"
    },
    {
      "affiliations": [
        "Baptist Health South Florida, Miami, FL"
      ],
      "name": "S Rahman Chowdhury"
    },
    {
      "affiliations": [
        "Florida International University Herbert Wertheim College of Medicine, Miami, FL",
        "Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL"
      ],
      "name": "AL Coon"
    },
    {
      "affiliations": [
        "Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL"
      ],
      "name": "I Linfante"
    },
    {
      "affiliations": [
        "Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL"
      ],
      "name": "G Dabus"
    },
    {
      "affiliations": [
        "Florida International University Herbert Wertheim College of Medicine, Miami, FL",
        "Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL"
      ],
      "name": "R Wicks"
    }
  ],
  "title": "E-255 Hematoma thickness as a predictor of outcomes following middle meningeal artery embolization: a preliminary analysis",
  "uid": "54c8f7ca-0d38-536a-a534-71f216a17ee3"
}