{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T16:18:11Z","timestamp":1778084291190,"version":"3.51.4"},"reference-count":25,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T00:00:00Z","timestamp":1750204800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Interv Neuroradiol"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Performing a craniotomy for chronic subdural hematoma (cSDH) in elderly patients with comorbidities can be challenging. The Subdural Evacuating Port System (SEPS; Medtronic, Dublin, Ireland) offers a less-invasive alternative, while middle meningeal artery embolization (MMAE) has shown effectiveness in preventing cSDH recurrence. However, the combined effectiveness of SEPS and MMAE (SEPS\u2009+\u2009MMAE) remains unclear. This study reports the outcomes of patients undergoing a combination of these procedures for the treatment of cSDH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review of our medical records database was conducted to identify patients with cSDH who were treated with SEPS\u2009+\u2009MMAE between January 1, 2021, and April 1, 2024. Demographics, comorbidities, procedure, and outcomes data were analyzed. cSDH resolution was tracked by measuring hematoma volumes on noncontrast computed tomography scans pre-SEPS\u2009+\u2009MMAE, 24\u201348\u2005h postprocedure, and 6\u20138 weeks postprocedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 35 patients (median age: 77 years [interquartile range (IQR):69\u201385.5]; men:woman\u2009=\u200922:13) with 49\u2005cSDH, of which 41\u2005cSDHs receiving combined SEPS\u2009+\u2009MMAE were included. Notably, 38 (92.7%) of the 41\u2005cSDHs were holohemispheric, and 15 (36.6%) had an acute or subacute component. The median pre-SEPS\u2009+\u2009MMAE cSDH volume was 121.9\u2005mL [IQR:87.9\u2013153.4\u2005mL] with a median midline shift of 6.6\u2005mm [IQR:3.5\u201310\u2005mm]. All MMAE procedures were performed under conscious sedation. The femoral approach was utilized in 19 patients (54.3%). Three patients required rescue craniotomy. Median post-SPES\u2009+\u2009MMAE volume was 71.1\u2005mL [IQR:54.5\u201393.2], resulting in a 38% [IQR:21.9\u201353] reduction in cSDH volume; and median follow-up SEPS\u2009+\u2009MMAE volume was 22\u2005mL [IQR:2\u201359.2] resulting in an 81% [IQR:50.9\u201398.1] reduction in cSDH volume, compared to pre-SEPS\u2009+\u2009MMAE levels. Seven (17.1%) patients required readmission for residual or recurrent cSDH within 90 days. Five of these patients were retreated (12.2%), two of whom required craniotomy (4.9%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our experience suggests that SEPS\u2009+\u2009MMAE was an effective method of cSDH treatment and was associated with low complication rates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15910199251342309","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T05:28:22Z","timestamp":1750224502000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Effectiveness of subdural evacuating port system (SEPS) and middle meningeal artery embolization (MMAE) for chronic subdural hematomas"],"prefix":"10.1177","author":[{"given":"Vinay","family":"Jaikumar","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"},{"name":"Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9847-3601","authenticated-orcid":false,"given":"Jaims","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"},{"name":"Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Wahlig","sequence":"additional","affiliation":[{"name":"Department of Molecular Biophysics and Biochemistry [student], Yale University, New Haven, CT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew K","family":"Moser","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"},{"name":"Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Rupp","sequence":"additional","affiliation":[{"name":"Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marissa D","family":"Kruk","sequence":"additional","affiliation":[{"name":"Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4500-7954","authenticated-orcid":false,"given":"Muhammad","family":"Waqas","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"},{"name":"Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Devan","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"},{"name":"Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander G","family":"Fritz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"},{"name":"Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andre","family":"Monteiro","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"},{"name":"Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamid Sharif","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"},{"name":"Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyler A","family":"Scullen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"},{"name":"Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehdi","family":"Bouslama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"},{"name":"Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kunal P","family":"Raygor","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"},{"name":"Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8310-0474","authenticated-orcid":false,"given":"Pui Man Rosalind","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"},{"name":"Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth V","family":"Snyder","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"},{"name":"Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA"},{"name":"Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA"},{"name":"Jacobs Institute, Buffalo, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6208-3724","authenticated-orcid":false,"given":"Elad I","family":"Levy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"},{"name":"Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA"},{"name":"Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA"},{"name":"Jacobs Institute, Buffalo, NY, USA"},{"name":"Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5225-3072","authenticated-orcid":false,"given":"Jason M","family":"Davies","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"},{"name":"Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA"},{"name":"Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA"},{"name":"Jacobs Institute, Buffalo, NY, USA"},{"name":"Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9519-0059","authenticated-orcid":false,"given":"Adnan H","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"},{"name":"Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA"},{"name":"Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA"},{"name":"Jacobs Institute, Buffalo, NY, USA"},{"name":"Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 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