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Middle meningeal artery embolization reduces the post-operative recurrence rate of at-risk chronic subdural hematoma
  1. Eimad Shotar1,
  2. Louis Meyblum1,
  3. Kevin Premat1,2,
  4. Stéphanie Lenck1,
  5. Vincent Degos2,3,
  6. Teodor Grand1,
  7. Jonathan Cortese1,
  8. Arnaud Pouvelle1,
  9. Geoffroy Pouliquen1,
  10. Samuel Mouyal1,
  11. Anne-Laure Boch4,
  12. Alexandre Carpentier2,4,
  13. Nader-Antoine Sourour1,
  14. Bertrand Mathon2,4,
  15. Frédéric Clarençon1,2
  1. 1 Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
  2. 2 Sorbonne Université, Paris, France
  3. 3 Neurosurgical Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
  4. 4 Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France
  1. Correspondence to Dr Eimad Shotar, Neuroradiology Department, Pitié-Salpêtrière Hospital, Paris, France; eimad.shotar{at}


Background Embolization of the middle meningeal artery (MMA) has emerged as a potential treatment of chronic subdural hematomas (CSDHs).

Objective To evaluate the impact on recurrence rate of postsurgical embolization of CSDH in patients with a higher than average risk of recurrence.

Methods A monocentric retrospective study was performed on retrospectively collected data. From March 2018 to December 2019, embolization of the MMA was proposed as an adjunct postoperative treatment after burr-hole surgery in patients operated for a recurrent CSDH or a CSDH with an independent recurrence risk factor, including antiplatelet therapy, full anticoagulation therapy, coagulation disorder, hepatopathy, or chronic alcoholism. Patients who had undergone postoperative embolization were compared with a historic group of patients operated between March 2016 and March 2018, selected based on the same inclusion criteria.

Results During the study period, 89 patients (with 74 unilateral and 15 bilateral CSDHs) were included and underwent an embolization procedure, leading to 91 out of a total of 104 MMA being embolized (88%). These were compared with 174 patients (138 unilateral and 36 bilateral CSDH) in the historic control group. One major procedure-related adverse event was registered. Four of the 89 patients (4%) required surgery for a CSDH recurrence in the embolization group, significantly less than the 24 of 174 patients (14%) in the control group (OR=0.28, 95% CI 0.07 to 0.86, p=0.02).

Conclusions Postsurgical embolization of the MMA may reduce the recurrence rate of CSDHs with a risk factor of recurrence.

  • chronic subdural hematoma
  • middle meningeal artery
  • recurrence
  • embolization

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  • Contributors Study design: ES, LM, BM, FC; Study oversight: FC; Data collection: ES, LM, TG, JC, AP, GP, SM; Statistical analysis: ES, LM; Manuscript preparation: ES; Critical review of the manuscript: all coauthors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests FC reports conflict of interest (unrelated) with Medtronic, Guerbet, Balt Extrusion (payment for readings), Codman Neurovascular (core laboratory). N-AS is consultant for Medtronic, Balt Extrusion, Microvention. The other authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. The manuscript is not supported by industry. ES is principal investigator of a randomized controlled trial related to chronic subdural hematomas embolization financed by a PHRC-IR public grant (non-related to the present study).

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request from the corresponding author.