Comparative Effectiveness of Endovascular Therapies and Language-Based Equity in the Management of Non-Acute Subdural Hematomas

Abstract

Non‐acute subdural hematomas (NASDH) are intracranial hemorrhages that form between the dura mater and the arachnoid membrane, typically arising from disruption of bridging veins and expanding to displace brain tissue, causing significant neurological manifestations.(1) Their incidence increases with age‐related factors such as antithrombotic use and cerebral atrophy, and it is projected that by 2030, NASDH will become the most common cranial neurosurgical condition.(2) More than two decades ago, Mandai et al. first described middle meningeal artery embolization (MMAE) as an intervention to disrupt the inflammatory mechanisms driving hematoma expansion and recurrence.(3) Since then, MMAE has attracted considerable attention in the fields of interventional radiology, neurology, and neurosurgery, as evidenced by the release of three simultaneous phase‐3 clinical trials supporting its use as an adjunctive therapeutic strategy. However, studies have historically pooled adjunctive and standalone MMAE cases together in a single study group. As a result, little comparative data on its effectiveness as a standalone treatment is available. Accordingly, our first project investigates whether patients treated exclusively with MMAE achieve fewer reintervention events, shorter hospitalizations, and reduced adverse events in comparison to those who undergo surgical evacuation alone. Undeniably, biological factors and interventions are not the only determinants of patient outcomes.(4) Today, we have considerable evidence on how social and contextual features may impact outcomes of clinical relevance in many patient populations. This may be especially pertinent for NASDH,(5) which disproportionately impacts older adult males with multiple comorbidities, some of whom are immigrants with limited English familiarity. Building on previous research that linked language disparities to clinical outcomes in various neurosurgical populations,(6) our second project examines whether similar patterns emerged in NASDH patients treated at a single academic center over the past seven years, while also accounting for other clinical and sociodemographic influences.