• Mohamed M Salem, Georgios S Sioutas, Jane Khalife, Okkes Kuybu, Kate Caroll, Alex Nguyen Hoang, Ammad A Baig, Mira Salih, Mirhojjat Khorasanizadeh, Cordell Baker, Aldo A Mendez, Gustavo Cortez, Zachary A Abecassis, Juan F Ruiz Rodriguez, Jason M Davies, Sandra Narayanan, C Michael Cawley, Howard A Riina, Justin M Moore, Alejandro M Spiotta, Alexander A Khalessi, Brian M Howard, Ricardo Hanel, Omar Tanweer, Daniel A Tonetti, Adnan H Siddiqui, Michael J Lang, Elad I Levy, Peter Kan, Tudor Jovin, Ramesh Grandhi, Visish M Srinivasan, Christopher S Ogilvy, Bradley A Gross, Brian T Jankowitz, Ajith J Thomas, Michael R Levitt, and Jan-Karl Burkhardt.
• Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
• Neurosurgery. 2024 Feb 27.

Background And ObjectivesThe choice of anesthesia type (general anesthesia [GA] vs nongeneral anesthesia [non-GA]) in middle meningeal artery embolization (MMAE) procedures for chronic subdural hematomas (cSDH) differs between institutions and left to care team discretion given lack of standard guidelines. We compare the outcomes of GA vs non-GA in MMAE.MethodsConsecutive patients receiving MMAE for cSDH at 14 North American centers (2018-2023) were included. Clinical, cSDH characteristics, and technical/clinical outcomes were compared between the GA/non-GA groups. Using propensity score matching (PSM), patients were matched controlling for age, baseline modified Rankin Scale, concurrent/prior surgery, hematoma thickness/midline shift, and baseline antiplatelet/anticoagulation. The primary end points included surgical rescue and radiographic success rates (≥50% reduction in maximum hematoma thickness with minimum 2 weeks of imaging). Secondary end points included technical feasibility, procedural complications, and functional outcomes.ResultsSeven hundred seventy-eight patients (median age 73 years, 73.2% male patients) underwent 956 MMAE procedures, 667 (70.4%) were non-GA and 280 were GA (29.6%). After running 1:3 PSM algorithm, this resulted in 153 and 296 in the GA and non-GA groups, respectively. There were no baseline/procedural differences between the groups except radial access more significantly used in the non-GA group (P = .001). There was no difference between the groups in procedural technical feasibility, complications rate, length of stay, surgical rescue rates, or favorable functional outcome at the last follow-up. Subsequent 1:1 sensitivity PSM retained the same results. Bilateral MMAE procedures were more performed under non-GA group (75.8% vs 67.2%; P = .01); no differences were noted in clinical/radiographic outcomes between bilateral vs unilateral MMAE, except for longer procedure duration in the bilateral group (median 73 minutes [IQR 48.3-100] vs 54 minutes [39-75]; P < .0001). Another PSM analysis comparing GA vs non-GA in patients undergoing stand-alone MMAE retained similar associations.ConclusionWe found no significant differences in radiological improvement/clinical outcomes between GA and non-GA for MMAE.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.

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