{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T23:15:24Z","timestamp":1788304524218,"version":"build-2803163510"},"reference-count":31,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rofo"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>To evaluate the safety and efficacy of middle meningeal artery embolization (MMAE) using small polyvinyl alcohol (PVA) particles (45\u2013150 \u00b5m) with or without coils for chronic subdural hematoma (cSDH) and to assess peri-interventional imaging predictors and survival outcomes.<\/jats:p>\n                  <jats:p>This retrospective single-center observational study included patients (\u226518 years) undergoing MMAE for cSDH between June 2019 and March 2024 at a tertiary neurovascular center. Inclusion criteria required pre-, post-interventional imaging and clinical follow-up; exclusions were acute traumatic hematomas, embolization with liquid embolics or coils alone, and insufficient imaging quality. Embolization was performed using PVA particles between 45\u2013150 \u00b5m in size with or without coils. Primary endpoint: need for retreatment. Secondary endpoints: radiological hematoma evolution, modified Rankin Scale (mRS) score, procedure-related complications, and mortality. Statistical analysis included Cochran\u02bcs Q test, Friedman ANOVA, \u03c7\u00b2 tests, Fisher's exact and Mann-Whitney U tests Kaplan-Meier, time-to-event analyses including sensitivity analyses accounting for bilateral hematomas and heterogeneous follow\u2011up.<\/jats:p>\n                  <jats:p>Eighty-nine patients (117 hematomas; mean age 80.9\u00b19.1 years; 80.9% male) were included. PVA alone was used in 29 hematomas (24.8%) and PVA with coils in 88 hematomas (75.2%). Retreatment was not required in 90.6 % of hematomas. Radiological success (complete resorption or residual thickness &lt;10 mm) was achieved in 71.0%. Mean baseline hematoma width was 19.2 \u00b1 6.7 mm. Across all hematomas, the median individual reduction in width from baseline to last follow-up was 77.3 % (p &lt; 0.001). The proportion of patients with mRS&lt;3 improved significantly from 52.8% pre-intervention to 76.4% at last follow-up (p&lt;0.001). Dyna-CT fluid level was associated with secondary radiological outcome in unadjusted analysis (p=0.002). PVA alone versus PVA with coils showed no difference in primary outcome or secondary outcomes. Procedure-related clinical complications occurred in 1.7% of embolizations (2\/117).<\/jats:p>\n                  <jats:p>MMAE with small PVA particles (45\u2013150 \u00b5m), with or without coils, is safe and effective for cSDH patients. The low clinical complication rate and absence of procedure-related mortality, combined with favorable survival, support small PVA particles as an effective embolic agent for MMAE in routine clinical practice.<\/jats:p>","DOI":"10.1055\/a-2933-2186","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T22:34:55Z","timestamp":1788302095000},"source":"Crossref","is-referenced-by-count":0,"title":["Middle Meningeal Artery Embolization with Small Polyvinyl Alcohol Particles (45\u2013150 \u00b5m) for Chronic Subdural Hematoma: Safety, Efficacy, and Imaging Predictors"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5571-7898","authenticated-orcid":false,"given":"Mahmoud Zaki Gaafar","family":"Zaki","sequence":"additional","affiliation":[{"name":"University Hospital Augsburg, Germany","place":["Augsburg"],"department":["Neuroradiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ansgar","family":"Berlis","sequence":"additional","affiliation":[{"name":"University Hospital Augsburg, Germany","place":["Augsburg"],"department":["Neuroradiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Behrens","sequence":"additional","affiliation":[{"name":"University Hospital Augsburg, Germany","place":["Augsburg"],"department":["Neuroradiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Humberto Abraham","family":"Cort\u00e9s Magdaleno","sequence":"additional","affiliation":[{"name":"University Hospital Augsburg, Germany","place":["Augsburg"],"department":["Neuroradiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f6rn","family":"Sommer","sequence":"additional","affiliation":[{"name":"University Hospital Augsburg, Germany","place":["Augsburg"],"department":["Neurosurgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Maurer","sequence":"additional","affiliation":[{"name":"University Hospital Augsburg, Germany","place":["Augsburg"],"department":["Neuroradiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1136\/jnnp.74.7.937","article-title":"Outcome of contemporary surgery for chronic subdural haematoma: Evidence based review","volume":"74","author":"R Weigel","year":"2003","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.3171\/2014.9.JNS141550","article-title":"Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations","volume":"123","author":"D Balser","year":"2015","journal-title":"J Neurosurg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1097\/SLA.0000000000000255","article-title":"Chronic subdural hematoma management: A systematic review and meta-analysis of 34,829 patients","volume":"259","author":"SA Almenawer","year":"2014","journal-title":"Ann Surg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1186\/s12974-017-0881-y","article-title":"Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy","volume":"14","author":"E Edlmann","year":"2017","journal-title":"J Neuroinflammation"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1136\/neurintsurg-2021-017352","article-title":"Middle meningeal artery embolization for chronic subdural hematoma: A systematic review and meta-analysis","volume":"13","author":"N Ironside","year":"2021","journal-title":"J Neurointerv 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Comparing PVA particle size in MMA embolization","volume":"16","author":"C Wakelin","year":"2024","journal-title":"J Neurointerv Surg"},{"key":"ref13","first-page":"1696","article-title":"Postoperative recurrence of chronic subdural hematoma is more frequent in patients with blood extravasation in the hematoma cavity on postoperative computed tomography","volume":"21","author":"S Hirai","year":"2014","journal-title":"J Clin Neurosci"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"e647","DOI":"10.1016\/j.wneu.2020.03.188","article-title":"DynaCT enhancement of subdural membranes after middle meningeal artery embolization: Insights into pathophysiology","volume":"139","author":"MC Mureb","year":"2020","journal-title":"World Neurosurg"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00062-025-01549-w","article-title":"Middle meningeal artery embolization for chronic subdural hematomas: A German nationwide multicenter study on 718 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