Search for a command to run...
<h3>Introduction</h3> Chronic subdural hematoma (cSDH) is a frequently encountered neurosurgical condition with an anticipated increase in prevalence due to the aging population. Middle meningeal artery embolization (MMAE) has emerged as a less invasive, viable alternative and adjuvant therapy to traditional surgical evacuation techniques in the treatment of cSDH. Post-operative hematoma resolution is often only apparent on the computed tomography (CT) scan at the 6–12-week follow-up. There is no clear guidelines on immediate post-operative CT scans after uncomplicated MMAE. <h3>Methods</h3> Consecutive patients who underwent MMAE for primary or adjuvant treatment of cSDH between May 2019 to November 2022 were retrospectively analyzed. Data pertaining to treatment laterality, embolization material used, pre- and post-embolization neurologic examination as assessed by the Glasgow Coma Scale (GCS) score, and frequency, indication, and result of post-procedure CT imaging study completion were collected. The implication of immediate post-operative head CTs on clinical management was evaluated. <h3>Results</h3> A total of 80 patients who had 82 MMAE procedures were identified and included in the analysis. 77 patients (81.7%) had stable (i.e. equal or improved GCS) neurologic exam pre- and immediately post-operatively, 4 (4.9%) had neurologic decline, and 1 (1.2%) had no reported postoperative exam. Of 77 patients with stable postoperative clinical exams, 47 (61.0%) had postoperative head CT completed within 24 hours of the procedure, while 30 (38.96%) had no acute imaging. In 97.9% of studies done (46/47) the CT scan was obtained as part of a routine post-operative order set, with only one study completed for an overnight transient decline in neurological examination that was determined to be unrelated to the MMAE procedure. All planned routine studies for patients with stable post-operative neurologic exams were negative for acute pathology (e.g. increased cSDH, worsening mass effect/midline shift, acute intracranial hemorrhage, ischemic stroke) that would have changed post-operative management. <h3>Conclusion</h3> For patients with stable postoperative neurological examination following uncomplicated MMAE, planned routine CT imaging during the first 24 hours post-operatively failed to identify radiographic changes that would have altered management. Our findings demonstrate that it is safe to forgo routine postoperative CT scans after MMAE in neurologically stable patients, which can reduce unnecessary patient radiation exposure and healthcare costs. This study is limited by the single-center, retrospective design; further investigations into optimal MMAE post-procedure protocols in larger multicenter cohort studies are needed. <h3>Disclosures</h3> <b>A. Benchouia:</b> None. <b>M. Lafuente:</b> None. <b>M. Gaub:</b> None. <b>P. Rodriguez:</b> None. <b>L. Birnbaum:</b> None. <b>J. Mascitelli:</b> None. <b>F. Al Saiegh:</b> None.