{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T15:01:20Z","timestamp":1784646080535,"version":"3.55.0"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum des Saarlandes und Medizinische Fakult\u00e4t der Universit\u00e4t des Saarlandes"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurosurg Rev"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Arteriovenous shunting involving the middle meningeal artery (MMA) has been reported after cranial trauma, neurosurgical procedures, and endovascular interventions. However, its angiographic frequency and characteristics after chronic subdural hematoma (cSDH) surgery remain poorly defined. This study aimed to assess the frequency and angiographic features of MMA arteriovenous shunting in patients undergoing MMA embolization after surgical evacuation of cSDH. We retrospectively analyzed consecutive patients who underwent selective and superselective MMA angiography during MMA embolization after surgical evacuation of cSDH between January 2020 and March 2023. Angiograms were reviewed for angiographic evidence of arteriovenous shunting, shunt morphology, flow characteristics, venous drainage, relationship to embolization, and angiographic closure after embolization. Surgical technique was classified as burr-hole craniotomy or formal craniotomy. Thirty patients met the inclusion criteria. Angiographic evidence of MMA arteriovenous shunting was identified in 11 patients (36.7%). Shunting was significantly more frequent after craniotomy than after burr-hole craniotomy (90.9% vs. 5.3%, Fisher\u2019s exact test, p\u2009&lt;\u20090.001). Most shunts were detectable before microcatheter advancement, while superselective angiography improved visualization of shunt morphology and venous drainage. All shunts demonstrated low-flow angiographic characteristics without cortical venous reflux. Post-embolization control angiography demonstrated disappearance of the angiographic shunt in all affected patients. Low-flow arteriovenous shunting involving the MMA is a frequent angiographic finding in patients undergoing MMA embolization after cSDH surgery, particularly following craniotomy. These findings provide systematic angiographic characterization of a previously underrecognized postoperative vascular phenomenon. The clinical relevance of such shunting remains uncertain and warrants prospective investigation.<\/jats:p>","DOI":"10.1007\/s10143-026-04411-w","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T02:03:19Z","timestamp":1784599399000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Middle meningeal artery arteriovenous shunting after surgical evacuation of chronic subdural hematoma: a retrospective angiographic cohort study"],"prefix":"10.1007","volume":"49","author":[{"given":"Malvina","family":"Garner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik","family":"Fries","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alena","family":"Hau\u00dfmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Reith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4940-3575","authenticated-orcid":false,"given":"Umut","family":"Yilmaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"4411_CR1","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/j.nec.2016.11.010","volume":"28","author":"VR Desai","year":"2017","unstructured":"Desai VR, Scranton RA, Britz GW (2017) Management of recurrent subdural hematomas. Neurosurg Clin N Am 28:279\u2013286. https:\/\/doi.org\/10.1016\/j.nec.2016.11.010","journal-title":"Neurosurg Clin N Am"},{"key":"4411_CR2","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1186\/s12974-017-0881-y","volume":"14","author":"E Edlmann","year":"2017","unstructured":"Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KLH, Hutchinson PJ (2017) Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation 14:108. https:\/\/doi.org\/10.1186\/s12974-017-0881-y","journal-title":"J Neuroinflammation"},{"key":"4411_CR3","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1007\/BF01808443","volume":"55","author":"N Freckmann","year":"1981","unstructured":"Freckmann N, Sartor K, Herrmann HD (1981) Traumatic arteriovenous fistulae of the middle meningeal artery and neighbouring veins or dural sinuses. 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AJNR Am J Neuroradiol 22:992\u2013996","journal-title":"AJNR Am J Neuroradiol"},{"key":"4411_CR8","doi-asserted-by":"publisher","first-page":"e81","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.01.015","volume":"28","author":"K Miki","year":"2019","unstructured":"Miki K, Noguchi N, Mori M, Yamada T (2019) A case of ruptured micro-AVM diagnosed by superselective angiography. J Stroke Cerebrovasc Dis 28:e81\u2013e83. https:\/\/doi.org\/10.1016\/j.jstrokecerebrovasdis.2019.01.015","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"4411_CR9","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.3171\/2018.8.JNS18805","volume":"131","author":"K Miki","year":"2019","unstructured":"Miki K, Abe H, Morishita T, Hayashi S, Yagi K, Arima H, Inoue T (2019) Double crescent sign as a predictor of chronic subdural hematoma recurrence following burr-hole surgery. 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Cerebrovasc Dis 55:125\u2013135. https:\/\/doi.org\/10.1159\/000546001","journal-title":"Cerebrovasc Dis"}],"container-title":["Neurosurgical Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10143-026-04411-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10143-026-04411-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10143-026-04411-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T14:03:09Z","timestamp":1784642589000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10143-026-04411-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4411"],"URL":"https:\/\/doi.org\/10.1007\/s10143-026-04411-w","relation":{},"ISSN":["1437-2320"],"issn-type":[{"value":"1437-2320","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]},"assertion":[{"value":"5 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 July 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 July 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All procedures performed in this study were in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments. A retrospective analysis of anonymized clinical and angiographic data was performed. The study was approved by the local German ethics committee (Ethikkommission der \u00c4rztekammer des Saarlandes, Saarbr\u00fccken, Germany), No. 221\/22.","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Clinical trial number","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All patients consented to the procedures and medical treatment performed. The requirement for additional informed consent for this retrospective analysis was waived by the local ethics committee.","order":4,"name":"Ethics","label":"Patient consent","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"487"}}