{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T02:17:28Z","timestamp":1768357048875,"version":"3.49.0"},"reference-count":21,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Surg Interv Health Technologies"],"accepted":{"date-parts":[[2025,2,11]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess recurrence rates, procedural outcomes and patient outcomes following middle meningeal artery (MMA) embolization for the treatment of chronic subdural hematomas (cSDH).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective case series.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Two tertiary neurosurgical referral centers in Sydney, Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>13 adult patients (mean age\u00b1SD, 68.5\u00b19.5 years, 11 male) with 17 cSDHs (measuring 13.8\u00b14.5\u2009mm) undergoing MMA embolization alone (8\/13) or with surgical evacuation (5\/13) for cSDH. There were no exclusion criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Embolization was performed via femoral access, using either liquid embolic, polyvinyl alcohol particles, coils, or a combination of agents. Embolization was done either as the sole treatment or with surgical evacuation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Primary outcomes were recurrence or increase in hematoma size requiring surgical evacuation. Secondary outcomes included procedural complications, hematoma size at follow-up, and patient clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>No procedural complications occurred. 12 patients were discharged home at baseline neurological function, and one was discharged to an aged care facility with significant disability. At follow-up (mean=8.7 weeks), combined embolization with surgical evacuation led to hematoma size reduction (14.3\u00b12.6\u2009mm to 5.7\u00b16.5\u2009mm, p&lt;0.01), while embolization alone showed a stable hematoma size (13.3\u00b15.7\u2009mm to 10.0\u00b18.8\u2009mm, p=0.20). Recurrence or increase in hematoma size requiring surgical evacuation occurred in 2\/13 (15.4%) patients, one of whom received only unilateral embolization, and the other received partial coiling due to the presence of dangerous collaterals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MMA embolization is a safe procedure that may reduce recurrence rates of cSDH when used as an adjunct to surgery or as a sole treatment. Possible reasons for treatment failure may include unilateral embolization, partial coiling, and absence of distal penetration of embolic agent. Large randomized control trials are currently in progress to assess the safety and efficacy of MMA embolization for this purpose.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjsit-2024-000290","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T06:52:53Z","timestamp":1743144773000},"page":"e000290","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Middle meningeal artery embolization for chronic subdural hematoma"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8327-5637","authenticated-orcid":false,"given":"Malgorzata","family":"Maciaszek","sequence":"first","affiliation":[{"name":"Royal North Shore Hospital, St Leonards, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brendan","family":"Steinfort","sequence":"additional","affiliation":[{"name":"Royal North Shore Hospital, St Leonards, New South Wales, Australia"},{"name":"Westmead Hospital, Westmead, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Harrington","sequence":"additional","affiliation":[{"name":"Royal North Shore Hospital, St Leonards, New South Wales, Australia"},{"name":"Westmead Hospital, Westmead, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken","family":"Faulder","sequence":"additional","affiliation":[{"name":"Royal North Shore Hospital, St Leonards, New South Wales, Australia"},{"name":"Westmead Hospital, Westmead, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nazih","family":"Assaad","sequence":"additional","affiliation":[{"name":"Royal North Shore Hospital, St Leonards, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Dexter","sequence":"additional","affiliation":[{"name":"Westmead Hospital, Westmead, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Ma","sequence":"additional","affiliation":[{"name":"Royal North Shore Hospital, St Leonards, New South Wales, Australia"},{"name":"Westmead Hospital, Westmead, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"key":"2026011310311907000_7.1.e000290.1","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.3171\/2018.12.JNS183035","article-title":"The incidence of chronic subdural hematomas from 1990 to 2015 in a defined Finnish population","volume":"132","author":"Rauhala","year":"2020","journal-title":"J Neurosurg"},{"key":"2026011310311907000_7.1.e000290.2","first-page":"1149","article-title":"Epidemiology of chronic subdural hematomas","volume":"39","author":"Karibe","year":"2011","journal-title":"No Shinkei Geka"},{"key":"2026011310311907000_7.1.e000290.3","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-020-04398-3"},{"key":"2026011310311907000_7.1.e000290.4","doi-asserted-by":"crossref","DOI":"10.1016\/j.bas.2021.100300","article-title":"Chronic Subdural Hematoma (cSDH): A review of the current state of the art","volume":"1","author":"Nouri","year":"2021","journal-title":"Brain Spine"},{"key":"2026011310311907000_7.1.e000290.5","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2020.560269","article-title":"Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study","volume":"11","author":"Cofano","year":"2020","journal-title":"Front Neurol"},{"key":"2026011310311907000_7.1.e000290.6","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1981.54.5.0637"},{"key":"2026011310311907000_7.1.e000290.7","doi-asserted-by":"crossref","DOI":"10.1186\/s12974-017-0881-y","article-title":"Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy","volume":"14","author":"Edlmann","year":"2017","journal-title":"J Neuroinflammation"},{"key":"2026011310311907000_7.1.e000290.8","first-page":"697","article-title":"Histological study of the outer membrane of chronic subdural hematoma: possible mechanism for expansion of hematoma cavity","volume":"21","author":"Nagahori","year":"1993","journal-title":"No Shinkei Geka"},{"key":"2026011310311907000_7.1.e000290.9","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2000.93.4.0686"},{"key":"2026011310311907000_7.1.e000290.10","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2017170053"},{"key":"2026011310311907000_7.1.e000290.11","unstructured":"National Institutes of Health . 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