{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:28:32Z","timestamp":1792787312626,"version":"4.5.0"},"reference-count":22,"publisher":"BMJ","funder":[{"name":"The Missy Project","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2025,9,29]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Headache is a common and disabling symptom after aneurysmal subarachnoid hemorrhage (aSAH), often requiring high-dose opioids. Meningeal inflammation and dural nociceptor activation may contribute. The middle meningeal artery (MMA), which supplies the dura, offers a route for targeted therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate whether dural infusion of lidocaine\u00b1dexamethasone during aneurysm embolization reduces pain and opioid use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between February and June 2025, nine patients with aSAH (Hunt and Hess grade 1\u20132 with Visual Analog Scale (VAS) score \u22657 were prospectively assigned to: (1) lidocaine+dexamethasone (L+D, n=3), (2) lidocaine only (L, n=3), or (3) no infusion (Control, n=3). MMA infusion was performed during embolization using a standard microcatheter technique. VAS was recorded at baseline, immediately postoperatively, 4\u201324 hours, 7 days, and 1 month. Primary outcomes were pain reduction and opioid use (oral morphine equivalents, OME). Statistical comparisons used non-parametric tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Postoperative median VAS fell from 7.0 to 6.0 in Controls (14%), 8.0 to 2.0 in L+D (75%), 8.0 to 4.0 in L (50%) (pooled P=0.016). First-day pain burden: 31 (Control), 9 (L+D), 21 (L), 15 (pooled; P=0.012). Early subacute burden: 9 (Control), 5 (L+D), 7 (L), 6 (pooled; P=0.024). Late subacute: 6 (Control), 3 (L+D), 5 (L), 4 (pooled; P=0.029). Cumulative burden: 42 (Control), 16 (L+D), 30 (L), 23 (pooled; P=0.012). Median OME: 16.7 mg (Control), 5.6 mg (L+D), 0 mg (L), 2.8 mg (pooled). There were no complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MMA infusion appears safe and may provide sustained, opioid-sparing pain relief after aSAH. Larger studies are needed to confirm efficacy and to optimize protocols.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jnis-2025-024125","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T09:35:13Z","timestamp":1761039313000},"page":"jnis-2025-024125","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Middle meningeal artery infusion for headaches after aneurysmal subarachnoid hemorrhage: a pilot study"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1383-8278","authenticated-orcid":false,"given":"Tongyu","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7399-839X","authenticated-orcid":false,"given":"Matias 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