General Versus Nongeneral Anesthesia for Middle Meningeal Artery Embolization for Chronic Subdural Hematomas: Multicenter Propensity Score Matched Study

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; Jan-Karl Burkhardt

doi:10.1227/neu.0000000000002874

General Versus Nongeneral Anesthesia for Middle Meningeal Artery Embolization for Chronic Subdural Hematomas: Multicenter Propensity Score Matched Study

Neurosurgery. 2024 Feb 27. doi: 10.1227/neu.0000000000002874. Online ahead of print.

Authors

Mohamed M Salem¹, Georgios S Sioutas¹, Jane Khalife², Okkes Kuybu³, Kate Caroll⁴, Alex Nguyen Hoang⁵, Ammad A Baig⁶, Mira Salih⁷, Mirhojjat Khorasanizadeh⁷, Cordell Baker⁸, Aldo A Mendez³, Gustavo Cortez⁹, Zachary A Abecassis⁴, Juan F Ruiz Rodriguez⁴, Jason M Davies⁶, Sandra Narayanan¹⁰, C Michael Cawley¹¹, Howard A Riina¹², Justin M Moore⁷, Alejandro M Spiotta¹³, Alexander A Khalessi¹⁴, Brian M Howard¹¹, Ricardo Hanel⁹, Omar Tanweer⁵, Daniel A Tonetti², Adnan H Siddiqui⁶, Michael J Lang³, Elad I Levy⁶, Peter Kan^{5

15}, Tudor Jovin², Ramesh Grandhi⁸, Visish M Srinivasan¹, Christopher S Ogilvy⁷, Bradley A Gross³, Brian T Jankowitz¹, Ajith J Thomas², Michael R Levitt⁴, Jan-Karl Burkhardt¹

Affiliations

¹ Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
² Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA.
³ Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁴ Department of Neurosurgery, University of Washington, Seattle, Washington, USA.
⁵ Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
⁶ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
⁷ Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Massachusetts, USA.
⁸ Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA.
⁹ Department of Cerebrovascular and Endovascular Surgery, Baptist Neurological Institute and Lyerly Neurosurgery, Jacksonville, Florida, USA.
¹⁰ Departments of Neurology and Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹¹ Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
¹² Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA.
¹³ Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
¹⁴ Department of Neurosurgery, University of California-San Diego, La Jolla, California, USA.
¹⁵ Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA.

PMID: 38412228
DOI: 10.1227/neu.0000000000002874

Abstract

Background and objectives: The 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.

Methods: Consecutive 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.

Results: Seven 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.

Conclusion: We found no significant differences in radiological improvement/clinical outcomes between GA and non-GA for MMAE.