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Original research
Radiographic clearance of chronic subdural hematomas after middle meningeal artery embolization
  1. Joshua S Catapano,
  2. Andrew F Ducruet,
  3. Visish M Srinivasan,
  4. Kavelin Rumalla,
  5. Candice L Nguyen,
  6. Caleb Rutledge,
  7. Tyler S Cole,
  8. Jacob F Baranoski,
  9. Michael T Lawton,
  10. Ashutosh P Jadhav,
  11. Felipe C Albuquerque
  1. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  1. Correspondence to Dr Felipe C Albuquerque, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ 85013, USA; neuropub{at}


Background Few reports discuss variables associated with improved outcomes after middle meningeal artery (MMA) embolization for chronic subdural hematomas (cSDHs). We analyzed radiographic evidence of cSDH clearance after MMA embolization to elucidate optimal techniques, hematoma clearance rates, and suitable length of follow-up.

Methods Patients who underwent MMA embolization for cSDH from January 1, 2018 through December 31, 2020 were analyzed. Patient characteristics, demographics, and technical procedural details were examined. Outcomes for cSDHs analyzed included complete or near-complete resolution at 30, 90, and 180 days following embolization. A multivariable logistic regression analysis identified variables predictive of rapid clearance and resolution of hematomas at 90 days.

Results The study cohort comprised 66 patients with 84 treated cSDHs. The mean (SD) cSDH size differed significantly at 30-day (8.8 (4.3) mm), 90-day (3.4 (3.0) mm), and 180-day (1.0 (1.7) mm) follow-up (p<0.001). More cSDHs had complete or near-complete resolution at 180 days (92%, 67/73) than at 90 (63%, 45/72) and 30 days (18%, 15/84) post-embolization (p<0.001). Only distal embolysate penetration was independently associated with rapid clearance (OR 3.9, 95% CI 1.4 to 11.1; p=0.01) and resolution of cSDHs at 90 days (OR 5.0, 95% CI 1.7 to 14.6; p=0.003).

Conclusion Although 63% of cSDHs with MMA embolization had complete or near-complete resolution by 90 days post-procedure, 92% reached this stage by 180 days. Therefore, 90-day follow-up may be insufficient to determine the effectiveness of MMA embolization for cSDHs, particularly compared with surgical evacuation alone. Also, distal MMA penetration may be associated with more rapid hematoma clearance.

  • subdural

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Data availability statement

No data are available. There are no additional data to share.

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  • Contributors JSC: data collection, writing, stats; KR: stats; CN: data collection; VMS: data collection, writing; CR: first edits; TSC: stats and first edits; JFB: data collection; MTL: edits; APJ: edits; AFD: edits; FCA: final approval, edits, and guarantor.

  • 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 AFD is a consultant for Medtronic, PLC (Dublin, Ireland), Penumbra, Inc (Alameda, CA), Stryker Corp (Kalamazoo, MI), Cerenovus (Johnson & Johnson Medical Devices Companies, New Brunswick, NJ), Oculus Imaging, LLC (Knoxville, TN), and Koswire, Inc (Flowery Branch, GA). AFD and FCA serve on the editorial board of the Journal of NeuroInterventional Surgery.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.