Operative Neurosurgery 30:270–277, 2026
This multicenter retrospective cohort assesses feasibility, safety, and short-term efficacy of performing middle meningeal artery embolization (MMAE) concurrently with surgical evacuation for chronic subdural hematoma in a single anesthetic session. Among 157 patients, technical success was 97.4%, radiographic improvement occurred in 91.7%, and 63.1% achieved ≥50% hematoma reduction, with a 10.8% overall complication rate and 0.6% procedure-related mortality.
The report compares outcomes to recent randomized trials and existing series, noting similar intraprocedural complication rates and favorable reintervention and functional-independence outcomes (83.9% mRS ≤2 at median 54 days). Authors highlight potential resource and LOS advantages, acknowledge retrospective limitations, and call for prospective studies to define long-term benefit, cost impact, and selection criteria.
Single-session MMAE plus evacuation: Performing middle meningeal artery embolization (MMAE) and surgical evacuation for chronic subdural hematoma (cSDH) in a single anesthetic session is feasible and technically successful in 97.4% of cases, with no major intraprocedural failures reported.
Safety profile: The overall complication rate for the combined procedure is 10.8%, with a low intraprocedural complication rate of 2.5% and a procedure-related mortality of 0.6%, comparable to or better than staged approaches and recent randomized trials.
Radiographic and functional outcomes: Radiographic improvement is observed in 91.7% of patients, with 63.1% achieving at least a 50% reduction in hematoma thickness; 83.9% of patients maintain or achieve functional independence (mRS ≤2) at short-term follow-up.
Hospital length of stay (LOS): The median hospital LOS is 6 days, which is slightly shorter than reported in comparable studies using staged procedures, suggesting potential for reduced resource utilization.
Reintervention rates: Unplanned reoperations during the index hospitalization are low (2.5%), including for recurrent hematomas and subdural empyema, which favorably compares to other large studies and randomized trials.
Patient selection and anesthesia: Most procedures use general anesthesia (92%), but monitored anesthesia care (MAC) or conscious sedation may further streamline care in selected patients and reduce anesthesia-related risks.
Applicability to complex cases: The single-session approach is effective and safe even in patients with bilateral cSDH, who are often considered more complex.
Future directions: Prospective studies are needed to assess long-term outcomes, cost-effectiveness, ideal patient selection, and whether this approach reduces recurrence and enhances recovery compared to staged strategies.
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