Understanding Risk Factors for Postoperative Seizure Following Surgical Treatment and Middle Meningeal Artery Embolization of Chronic Subdural Hematomas

Objective

Chronic subdural hematoma (cSDH) is often associated with clinical seizures, with incidence rates ranging from 2.6% to 23%. While risk factors like hematoma size and craniotomy with membranectomy are well established, the impact of middle meningeal artery embolization (MMAe) remains underexplored. This study aims to evaluate postoperative seizure rates in cSDH patients treated with MMAe and compare them with those undergoing craniotomy or burr hole evacuation.

Methods

A bi-institutional retrospective review of 580 cSDH cases treated with burr hole evacuation (with or without MMAe), craniotomy (with or without MMAe), or MMAe alone from 2017 to 2021 was conducted. Fisher exact tests, t tests, and analysis of variance were used to analyze patient, hematoma, and procedural characteristics. Logistic regression identified factors associated with postoperative seizures, complications, and recurrence requiring reoperation. Linear regression was used to assess factors influencing length of hospital stay.

Results

Among 580 cases, postoperative seizure rates were 4.2% for burr hole evacuation, 1.3% for burr hole evacuation with MMAe, 12.1% for craniotomy, 11.8% for craniotomy with MMAe, and 4.3% for MMAe alone. Logistic regression showed significantly higher seizure risk in craniotomy with MMAe vs. burr hole with MMAe (odds ratio [OR] 9.14, 95% CI 1.02-81.66, P = 0.047). Standalone MMAe had a lower complication risk than standalone burr hole drainage (OR 0.37, 95% CI 0.16-0.84, P = 0.017) or craniotomy (OR 0.37, 95% CI 0.17-0.79, P = 0.01).

Conclusions

Burr hole evacuation with MMAe had the lowest postoperative seizure rate, while MMAe alone was associated with the lowest risk of overall postoperative complications.