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Middle meningeal artery embolization: preventing subdural hematoma recurrence and saving money?
  1. Robert W Regenhardt1,
  2. Adam A Dmytriw2,
  3. Justin E Vranic2,
  4. Aman B Patel3,
  5. Christopher J Stapleton3
  1. 1 Neurosurgery and Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2 Neurosurgery and Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3 Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Christopher J Stapleton, Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA; cstapleton{at}

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‘Despite advances in the management of chronic subdural hematomas (cSDH), the cost of treatment has not decreased (and) investigations into the cost of cSDH treatment are warranted.’1

Middle meningeal artery (MMA) embolization has been gaining popularity for patients with cSDH. This is largely due to a growing population of patients with cSDH who are often refractory to other treatments. Indeed, it is estimated that there will be 60 000 newly diagnosed patients with cSDH per year by the end of the decade.2 Furthermore, there is growing evidence to support MMA embolization, from early case reports in the 2000s to recent large non-randomized studies.3–11 There are also at least 11 ongoing randomized trials to evaluate this approach (NCT04270955, NCT04750200, NCT03307395, NCT04742920, NCT04816591, NCT04372147, NCT04511572, NCT04402632, NCT04410146, NCT04095819, NCT04272996).12

While several outcomes have been studied after MMA embolization, there has been limited evaluation of the costs related to this treatment for healthcare systems. In their manuscript entitled ‘Total 1 year hospital cost of middle meningeal artery embolization compared with surgery for chronic subdural hematomas: a propensity-adjusted analysis’,1 the authors retrospectively evaluated 170 patients who presented with cSDH from 2018 to 2020 using a propensity-adjusted analysis; 72% were initially treated with surgery and 28% with MMA embolization. The surgery group had larger index SDH size (20.5 mm vs 16.9 mm, p<0.001), longer length of …

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  • Contributors RWR and CJS determined the content of the manuscript. RWR wrote the first draft. All authors read, edited, and approved the final manuscript.

  • Funding RWR has grant support from the National Institutes of Health.

  • Competing interests None declared.

  • 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.

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