{"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":1792787312562,"version":"4.5.0"},"reference-count":9,"publisher":"BMJ","funder":[{"name":"Medtronic","award":["There is no grant\/award number."],"award-info":[{"award-number":["There is no grant\/award number."]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2025,11,28]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Randomized clinical trials have demonstrated that middle meningeal artery embolization (MMAe) reduces reoperation rates in surgically treated patients with subacute\/chronic subdural hematoma (SDH). The effect of embolization on outcomes beyond reoperation remains to be determined. We analyzed the impact of reoperation and healthcare encounters among patients enrolled in the EMBOLISE trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Symptomatic subacute\/chronic SDH patients were randomized to surgical evacuation alone (control) or surgical evacuation plus Onyx MMAe (treatment). Changes in modified Rankin Scale (mRS) scores, frequency of unscheduled follow-up visits, and radiographic evolution of hematomas in patients with versus without reoperation were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 197 patients were randomly assigned to the treatment group and 203 to the control group. Patients who required reoperation compared with those who did not exhibited a ~threefold higher incidence of mRS &gt;2 (37.0% vs 12.9%, P=0.0025) and an ~2.5\u2009fold increase in mRS worsening (22.2% vs 9.5%, P=0.0503) at 180 days. In patients who did not receive MMAe, there was a ~threefold\u2009fold increase in rate of SDH recurrence\/progression even among those who did not require reoperation (14.3% vs 5.3%, P=0.0045) and a ~twofold\u2009increase in unscheduled physician follow-up visits (27.1% vs 14.7%, P=0.0031).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among patients with symptomatic subacute\/chronic SDH, reoperation was associated with increased rates of mRS worsening and higher mRS scores at follow-up. Adjunctive Onyx MMAe resulted in lower rates of hematoma recurrence\/progression and fewer unscheduled physician follow-up visits. Thus, in addition to reducing surgical reoperation rates, adjunctive MMAe led to improved clinical outcomes and reduced healthcare encounters.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jnis-2025-024587","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T18:20:33Z","timestamp":1766600433000},"page":"jnis-2025-024587","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["EMBOLISE randomized surgical trial for subdural hematoma: clinical benefits beyond reoperation with middle meningeal artery embolization"],"prefix":"10.1136","author":[{"given":"Jared","family":"Knopman","sequence":"first","affiliation":[{"name":"Neurological Surgery, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5225-3072","authenticated-orcid":false,"given":"Jason M","family":"Davies","sequence":"additional","affiliation":[{"name":"Neurosurgery and Bioinformatics and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"},{"name":"Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxim","family":"Mokin","sequence":"additional","affiliation":[{"name":"Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA"},{"name":"Neurosurgery and Brain Repair, Tampa General Hospital, Tampa, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7148-7616","authenticated-orcid":false,"given":"Ameer E","family":"Hassan","sequence":"additional","affiliation":[{"name":"Neuroscience, University of Texas Rio Grande Valley, Harlingen, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E","family":"Harbaugh","sequence":"additional","affiliation":[{"name":"Neurosurgery and Engineering Science & Mechanics, Penn State University, Hershey, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Khalessi","sequence":"additional","affiliation":[{"name":"Neurological Surgery, Surgery, Radiology, and Neurosciences, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8533-7478","authenticated-orcid":false,"given":"Jens","family":"Fiehler","sequence":"additional","affiliation":[{"name":"Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6208-3724","authenticated-orcid":false,"given":"Elad I","family":"Levy","sequence":"additional","affiliation":[{"name":"Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA"},{"name":"Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6999-7967","authenticated-orcid":false,"given":"Bradley A","family":"Gross","sequence":"additional","affiliation":[{"name":"Neurosurgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9000-6083","authenticated-orcid":false,"given":"Ramesh","family":"Grandhi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah, 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Webster","family":"Crowley","sequence":"additional","affiliation":[{"name":"Neurosurgery, Rush University, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas W","family":"Link","sequence":"additional","affiliation":[{"name":"Neurosurgery, North Shore University Hospital, Great Neck, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5980-3989","authenticated-orcid":false,"given":"Justin F","family":"Fraser","sequence":"additional","affiliation":[{"name":"Neurological Surgery, Neurology, Radiology, Otolaryngology, and Neuroscience, University of Kentucky, Lexington, Kentucky, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3612-3347","authenticated-orcid":false,"given":"Michael R","family":"Levitt","sequence":"additional","affiliation":[{"name":"Neurological Surgery, Radiology, Neurology, Mechanical Engineering, and Stroke & Applied 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