{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T14:47:41Z","timestamp":1792075661724,"version":"4.4.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Neuroradiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Middle meningeal artery embolization (MMAE) is increasingly used for chronic subdural hematoma (CSDH), but the relationship between injected liquid-embolic volume and outcomes is unclear. We evaluated dose\u2013outcome associations and searched for a\u00a0minimum effective dose.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective multicenter cohort included 313 patients treated with liquid embolic agents at 12\u00a0MESH Registry centers from 2016 to 2024. MMAE was performed alone in 172 patients (55.0%) and adjunctively with surgical evacuation in 141 (45.0%). Dose was assessed as total injected volume per patient and normalized to middle meningeal artery diameter, baseline hematoma thickness, and estimated hematoma volume. The primary outcome was a\u00a0180-day composite of retreatment, residual or recurrent hematoma &gt;\u202f10\u202fmm, or death. Logistic regression with multiple imputation, restricted cubic splines, and sensitivity analyses evaluated associations and nonlinearity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median injected volume was 0.60\u202fmL (interquartile range, 0.50\u20130.90). Center accounted for 44.5% of variation in log volume, whereas hematoma burden accounted for 0.3%. No dose metric was significantly associated with the primary outcome or 90-day recurrence\/reoperation. For absolute volume, the odds ratio per interquartile-range increment was 0.80 (95% confidence interval, 0.56\u20131.16;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u20090.24). No reliable minimum effective dose was identified. Findings remained consistent across sensitivity analyses and treatment indications (interaction\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u20090.30). Procedural complications occurred in 6.4% and were not dose-associated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Within the observed range, injected volume alone was not a\u00a0consistent determinant of outcome and should not be a\u00a0procedural target after a\u00a0satisfactory angiographic endpoint. Future studies should evaluate embolic distribution, distal penetration, and vascular territory coverage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00062-026-01729-2","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T14:31:05Z","timestamp":1792074665000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Liquid Embolic Volume Does Not Predict Outcome After Middle Meningeal Artery Embolization for Chronic Subdural 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The \u201cBright Falx\u201d Sign-Midline Embolic Penetration Is Associated With Faster Resolution of Chronic Subdural Hematoma After Middle Meningeal Artery Embolization: A Case Series. 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Dominik F. Vollherbst, MD: Medtronic Markus A. M\u00f6hlenbruch, MD: Johnson & Johnson, Balt, Siemens, Medtronic, TerumoNeuro, Stryker Clemens M. Schirmer, MD: Medtronic, Stryker, Viz.ai, Balt, Microvention, Werfen, NTI, Reist, Penumbra, Cerenovus, Route 92, MIVI, NICO, NIH\/NINDS Fabio Settecase, MD, MSc: Stryker, Route 92 Medical, Medtronic, Microvention; Site-PI EMBOLISE trial Stavropoula Tjoumakaris, MD: MicroVention, Medtronic (Consultant, Research grant) Pascal Jabbour, MD: Medtronic, MicroVention, Balt, Cerus Endovascular (Consultant, Research grant) Kunal Vakharia, MD: Terumo Neuro, Phenox Wallaby, Imperative Care, NSF SBIR Grant Santiago Ortega\u2010Gutierrez, MD, MSc: Medtronic, Stryker Neurovascular, Microvention; NIH-NINDS (RO1NS127114-01, RO1NS138765, RO3NS126804), PCORI, Stryker, Medtronic, Microvention, Methinks; Institutional PI and Steering Committee: SEGA, TESLA, ENDOLOW and SELECT 2, SPLENDID, SUMMIT, MYSTIQUE; PI for US tandem Registry, CO-PI for VOTER registry, ATHENA, SMAR-LVO; PI for clinical trials: DIRECT and DONE SYMPLE Anil Gopinathan, MBBS, MD, FRCR (Lon), FAMS: Received funding\/honorarium payments for attending meetings\/conferences, writing expert medical reports, speaking in industry-sponsored sessions at conferences, conducting workshops for Balt, Becton Dickinson, Medtronic Neurovascular, Penumbra Inc, Stryker NV, Singapore Medical Council. All payments were made to and\/or routed through the employer. Jesse G Jones, MD: J&J, Scientia, TG Medical, Piraeus Medical; Investigator in EMBOLISE (Medtronic) and MEMBRANE (J&J) Eytan Raz, MD, PhD: Balt, Imperative Care, Johnson & Johnson MedTech, Medtronic, Phenox, Qapel, Route92, Scientia, Siemens, Terumo Neuro, Vasorum Jan-Karl Burkhardt, MD: Cerenovus, Stryker, Q\u2019Apel, Microvention, Siemens, National Football League Visish M. Srinivasan, MD: Cerenovus, Stryker, Imperative Care, IschemaView, National Football League; Grants \u2013 Zeiss, Medtronic, Stryker, Siemens Gaultier Marnat, MD: Consulting: Stryker, Balt, Terumo Neuro, Sim and Cure; Paid lectures: Wallaby Phenox, Cerenovus (Johnson & Johnson), Penumbra, Bracco, Medtronic Michael R Levitt, MD: Unrestricted educational grants from Medtronic and Stryker; consulting agreement with Aeaean Advisers, Metis Innovative, AIDoc, Phenox, Shepherd Vascular and Arsenal Medical; equity interest in Proprio, Stroke Diagnostics, Apertur, Fluid Biomed, Synchron and Hyperion Surgical; editorial board of JNIS Advances; board member of Society of NeuroInterventional Surgery Foundation, and Society of NeuroInterventional Surgery. Giuseppe Lanzino, MD: Superior Medical Editors, Nested Knowledge, Piraeus Medical Jared Knopman, MD: Medtronic, Stryker, Microvention, Balt, Phenox, Von Vascular, Hyperion, Stroke Diagnostics, Precision Recovery, Synchron, Blink TBI, viz.AI, Serenity Medical, Endostream; National PI, EMBOLISE Steering Committee David J Altschul, MD: Stock options in Galaxy Therapeutics and Glia Medical; securities holdings in Von Vascular, Inc.; and consulting compensation from Johnson & Johnson International, Medtronic USA, Inc., BE Therapeutics, Viz.ai, Q\u2019Apel, MicroVention, Inc., Longeviti Neuro Solutions LLC, Penumbra, Inc., Synchron, Sirtex Medical Inc., Stryker Corporation, Cerevasc, NuVascular, and Facebook. Ali Alaraj, MD, MHA: AA is a consultant for J&J MedTech Neurovascular and has received research grants from the Joe Niekro Foundation and J&J MedTech Neurovascular. AA serves as Editor-in-Chief of Neurological Research. All other authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This multicenter retrospective study was approved by the institutional review board or research ethics committee at each participating center and was conducted in accordance with the Declaration of Helsinki and its later amendments. The requirement for informed consent was waived by the participating institutions in accordance with local regulations because the study used retrospective, deidentified registry data.","order":2,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}}]}}