Tag: Middle meningeal artery embolization

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Single-Session Middle Meningeal Artery Embolization With Concomitant Evacuation Surgery for Chronic Subdural Hematomas: A Multicenter Assessment of Feasibility, Safety, and Efficacy

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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Automated Preoperative and Postoperative Volume Estimates Risk of Retreatment in Chronic Subdural Hematoma

Neurosurgery 94:317–324, 2024

Several neurosurgical pathologies, ranging from glioblastoma to hemorrhagic stroke, use volume thresholds to guide treatment decisions. For chronic subdural hematoma (cSDH), with a risk of retreatment of 10%–30%, the relationship between preoperative and postoperative cSDH volume and retreatment is not well understood. We investigated the potential link between preoperative and postoperative cSDH volumes and retreatment.

METHODS: We performed a retrospective chart review of patients operated for unilateral cSDH from 4 level 1 trauma centers, February 2009–August 2021. We used a 3-dimensional deep learning, automated segmentation pipeline to calculate preoperative and postoperative cSDH volumes. To identify volume thresholds, we constructed a receiver operating curve with preoperative and postoperative volumes to predict cSDH retreatment rates and selected the threshold with the highest Youden index. Then, we developed a light gradient boosting machine to predict the risk of cSDH recurrence.

RESULTS: We identified 538 patients with unilateral cSDH, of whom 62 (12%) underwent surgical retreatment within 6 months of the index surgery. cSDH retreatment was associated with higher preoperative (122 vs 103 mL; P < .001) and postoperative (62 vs 35 mL; P < .001) volumes. Patients with >140 mL preoperative volume had nearly triple the risk of cSDH recurrence compared with those below 140 mL, while a postoperative volume >46 mL led to an increased risk for retreatment (22% vs 6%; P < .001). On multivariate modeling, our model had an area under the receiver operating curve of 0.76 (95% CI: 0.60-0.93) for predicting retreatment. The most important features were preoperative and postoperative volume, platelet count, and age.

CONCLUSION: Larger preoperative and postoperative cSDH volumes increase the risk of retreatment. Volume thresholds may allow identification of patients at high risk of cSDH retreatment who would benefit from adjunct treatments. Machine learning algorithm can quickly provide accurate estimates of preoperative and postoperative volumes.

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Middle Meningeal Artery Embolization in Adjunction to Surgical Evacuation for Treatment of Subdural Hematomas

Neurosurgery 93:1082–1089, 2023

Surgical evacuation is the standard treatment for chronic subdural hematomas (CSDHs) but is associated with a high risk of recurrence and readmission. Middle meningeal artery embolization (MMAE) is a novel treatment approach which could be performed upfront or in adjunction to surgical evacuation. MMAE studies are limited by small sample sizes. This study aimed to describe and compare outcomes of MMAE in adjunction to surgery with those of surgery alone on a national level.

METHODS: The national Vizient Clinical Database was queried by use of a specific validated set of International Classification of Diseases, Tenth Revision codes (October 2018-June 2022). Patients with the diagnosis of nontraumatic CSDH who received MMAE and surgical drainage in the same hospitalization were identified, and their outcomes were compared with isolated surgical drainage.

RESULTS: A total of 606 subjects from 156 institutes and 6340 subjects from 369 institutes were included in the MMAE plus surgery (M&S) and surgery groups, respectively. Average length of stay was significantly longer in the M&S group (9.87 vs 7.53 days; P < .01). There was no significant difference in the in-hospital mortality rate (2.8% vs 2.9%), but the complication rate was significantly higher in the M&S group (8.7% vs 5.5%; P < .01). Complications that were significantly more common in the M&S group included aspiration pneumonia, postoperative sepsis, and anesthesia-related. Mean direct costs were significantly higher in the M&S group (28 834 vs 16 292 US dollars; P < .01). The 30-day readmission rate was significantly lower in the M&S group compared with the surgery group (4.2% vs 8.0%; P < .01).

CONCLUSION: This analysis of large-scale national data indicates that MMAE performed in adjunction to surgery for treatment of CSDH is associated with higher direct costs, higher complication rates, and longer length of stay but lower readmission rates compared with surgical evacuation alone.

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Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Review

Operative Neurosurgery 24:469–475, 2023

Middle meningeal artery embolization (MMAE) for chronic subdural hematomas (cSDHs) has evolved as a potential treatment alternative for these lesions. The indications for using this treatment modality and the pathophysiology of cSDHs are an area of considerable interest.

A retrospective review was performed including all major papers addressing this topic. Although considered a relatively new treatment option, MMAE for cSDHs is gaining widespread popularity. There are many questions that need to be addressed regarding its indications, some of which are the subject of ongoing clinical trials. The efficacy of this treatment modality in carefully selected patients has also provided new insights into the potential pathophysiology of cSDHs.

This concise review will focus on the current evidence supporting the use of embolization in the treatment of this disease and highlight unanswered relevant clinical questions regarding MMAE indications and technique.

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