{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T18:11:08Z","timestamp":1788891068470,"version":"build-2803163510"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["SVIN"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The EMBOLISE trial (The Embolization of the Middle Meningeal Artery With Onyx Liquid Embolic System in the Treatment of Subacute and Chronic Subdural Hematoma) demonstrated that middle meningeal artery embolization as an adjunct to surgical drainage reduces recurrence of symptomatic subacute and chronic subdural hematomas. We performed a subgroup analysis of the EMBOLISE surgical cohort to determine how the timing of embolization relative to surgery impacted various outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We performed a post hoc subgroup analysis to examine the association of the timing of embolization relative to surgery with the primary end point (hematoma reoperation within 90 days), secondary end points (clinical and radiographic outcomes), and safety end points (serious adverse events, neurological death, all-cause death, and stroke).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Middle meningeal artery embolization before surgery (embolization-first group) and middle meningeal artery embolization after surgery (surgery-first group) were performed in 107 and 78 patients, respectively. Demographics and baseline clinical characteristics of the 2 groups were similar. The core laboratory confirmed the procedure to be successful in all patients with similar rates of distal penetration of Onyx into middle meningeal artery branches at the end of the embolization procedure in both groups (49.5% and 48.7%, respectively,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt;0.99). Six of 103 patients in the embolization-first group (5.8%) and none in the surgery-first group needed reoperation within 90 days (analysis with observed data,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.08). Hematoma volumes at 90 and 180 days were similar except for lower hematoma thickness in the surgery-first group (2.3\u00b13.0\u2009mm versus 4.4\u00b15.6\u2009mm,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.03) at 180 days. Clinical and safety outcomes at 30, 90, and 180 days were similar.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Performing surgical drainage before embolization in patients with subacute and chronic subdural hematomas may help minimize treatment failures and enhance hematoma resolution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT04402632.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/svin.126.002359","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T09:00:10Z","timestamp":1786611610000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Timing of Middle Meningeal Artery Embolization and Surgery: Analysis of the EMBOLISE Trial"],"prefix":"10.1161","volume":"6","clinical-trial-number":[{"clinical-trial-number":"nct04402632","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4270-8667","authenticated-orcid":true,"given":"Maxim","family":"Mokin","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Brain and Spine, Tampa General Hospital, University of South Florida (M.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5871-5517","authenticated-orcid":true,"given":"Jared","family":"Knopman","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, New York Presbyterian Hospital\/Weill Cornell Medical Center (J.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5225-3072","authenticated-orcid":true,"given":"Jason M.","family":"Davies","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and Biomedical Informatics (J.M.D.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7148-7616","authenticated-orcid":true,"given":"Ameer E.","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Valley Baptist Medical Center\u2013University of Texas Rio Grande Valley, Harlingen (A.E.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Harbaugh","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and Engineering Science &amp; Mechanics, Penn State University, Hershey (R.E.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Khalessi","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery, Surgery, Radiology and Neurosciences, University of California San Diego (A.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8533-7478","authenticated-orcid":true,"given":"Jens","family":"Fiehler","sequence":"additional","affiliation":[{"name":"Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (J.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6208-3724","authenticated-orcid":true,"given":"Elad I.","family":"Levy","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and Radiology (E.I.L., A.H.S.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6999-7967","authenticated-orcid":true,"given":"Bradley A.","family":"Gross","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh Medical Center, PA (B.A.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9000-6083","authenticated-orcid":true,"given":"Ramesh","family":"Grandhi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City (R.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Tarpley","sequence":"additional","affiliation":[{"name":"Department of Radiology (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA."},{"name":"Pacific Neuroscience Institute, Santa Monica, CA (J.T., W.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1367-2100","authenticated-orcid":true,"given":"Walavan","family":"Sivakumar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (W.S.), Providence Little Company of Mary Medical Center, Torrance, CA."},{"name":"Pacific Neuroscience Institute, Santa Monica, CA (J.T., W.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Bain","sequence":"additional","affiliation":[{"name":"Cerebrovascular Center, Cleveland Clinic, OH (M.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9197-0437","authenticated-orcid":true,"given":"R. Webster","family":"Crowley","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University, Chicago, IL (R.W.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1325-8847","authenticated-orcid":true,"given":"Thomas W.","family":"Link","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, North Shore University Hospital at Northwell Health, Great Neck, NY (T.W.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5980-3989","authenticated-orcid":true,"given":"Justin F.","family":"Fraser","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery, Neurology, Radiology, Otolaryngology, and Neuroscience, University of Kentucky, Lexington (J.F.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3612-3347","authenticated-orcid":true,"given":"Michael R.","family":"Levitt","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery, Radiology, Neurology, Mechanical Engineering, and Stroke &amp; 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