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Original research
Middle meningeal artery embolization associated with reduced chronic subdural hematoma volume and midline shift in the acute postoperative period
  1. Joshua S Catapano,
  2. Stefan W Koester,
  3. Sahin Hanalioglu,
  4. Dara S Farhadi,
  5. Anant Naik,
  6. Joelle N Hartke,
  7. Osman Tunc,
  8. Ethan A Winkler,
  9. Steven W Chang,
  10. Michael T Lawton,
  11. Ashutosh P Jadhav,
  12. Andrew F Ducruet,
  13. Felipe C Albuquerque
  1. Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
  1. Correspondence to Dr Felipe C Albuquerque, c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, Arizona 85013, USA; neuropub{at}


Background Middle meningeal artery (MMA) embolization for endovascular treatment of chronic subdural hematoma (cSDH) is growing in popularity. cSDH volume and midline shift were analyzed in the immediate postoperative window after MMA embolization.

Methods A retrospective analysis of cSDHs managed via MMA embolization from January 1, 2018 to March 30, 2021 was performed at a large quaternary center. Pre- and postoperative cSDH volume and midline shift were quantified with CT. Postoperative CT was obtained 12 to 36 hours after embolization. Paired t-tests were used to determine significant reduction. Multivariate analysis was performed using logistic and linear regression for percent improvement from baseline volume.

Results In total, 80 patients underwent MMA embolization for 98 cSDHs during the study period. The mean (SD) initial cSDH volume was 66.54 (34.67) mL, and the mean midline shift was 3.79 (2.85) mm. There were significant reductions in mean cSDH volume (12.1 mL, 95% CI 9.32 to 14.27 mL, P<0.001) and midline shift (0.80 mm, 95% CI 0.24 to 1.36 mm, P<0.001). In the immediate postoperative period, 22% (14/65) of patients had a>30% reduction in cSDH volume. A multivariate analysis of 36 patients found that preoperative antiplatelet and anticoagulation use was significantly associated with an expansion in volume (OR 0.028, 95% CI 0.000 to 0.405, P=0.03).

Conclusion MMA embolization is safe and effective for the management of cSDH and is associated with significant reductions in hematoma volume and midline shift in the immediate postoperative period.

  • Embolic
  • Hemorrhage
  • Liquid Embolic Material
  • Meninges
  • Subdural

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  • Contributors Conception and design: JSC, FCA, MTL. Acquisition of data: JSC, SWK, DSF, SH. Analysis and interpretation of data: SWK,AN, SH, JSC. Drafting the article: SWK, AN, SH, DSF, JNH, OT. Critically revising the article: SWK, AN, SH, DSF, JNH, OT, EAW, AFD, APJ, SWC, MTL, FCA. Reviewed final version of the manuscript and approved it for submission: SWK, AN, SH, DSF, JNH, OT, EAW, AFD, APJ, SWC, MTL, FCA. Statistical analysis: SWK, AN, SH, JSC. Administrative/technical/material support: MTL, FCA. Study supervision: JSC, FCA, MTL. FCA is the 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 FCA and AFD serve on the editorial board of Journal of NeuroInterventional Surgery. The other authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this manuscript.

  • 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.