{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:37:10Z","timestamp":1790807830197,"version":"4.1.0"},"reference-count":10,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Middle meningeal artery embolization (MMAE) is an emerging endovascular treatment technique with proven promising results for chronic subdural hematomas (cSDHs). MMAE as an adjunct to open surgery is being utilized with the goal of preventing the recurrence of cSDH. However, the efficacy of MMAE following surgical evacuation of cSDH has not been clearly demonstrated. The authors sought to compare the outcomes of open surgery followed by MMAE versus open surgery alone.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Patients who underwent surgical evacuation alone (open surgery\u2013alone group) or MMAE along with open surgery for cSDH (adjunctive MMAE group) were identified at the authors\u2019 institution. Two balanced groups were obtained through propensity score matching. Primary outcomes included recurrence risk and reintervention rate. Secondary outcomes included decrease in hematoma size and modified Rankin Scale (mRS) score at last follow-up. Variables in the two groups were compared by use of the Mann-Whitney U-test, paired-sample t-test, and Fisher\u2019s exact test.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 345 cases of open surgery alone and 52 cases of open surgery with adjunctive MMAE were identified. After control for subjective confounders, 146 patients treated with open surgery alone and 41 with adjunctive MMAE following open surgery with drain placement were included in the analysis. Before matching, the rebleeding risk and reintervention rate for open surgery trended higher in the open surgery alone than the open surgery plus MMAE group (14.4% vs 7.3%, p = 0.18; and 11.6% vs 4.9%, p = 0.17, respectively). No significant differences were seen in duration of radiographic or clinical follow-ups or decreases in hematoma size and mRS score at last follow-up. After one-to-one nearest neighbor propensity score matching, 26 pairs of cases were compared for outcomes. Rates of recurrence (7.7% vs 30.8%, p = 0.038) and overall reintervention (3.8% vs 23.1%, p = 0.049) after open surgery were found to be significantly lower in the adjunctive MMAE group than the open surgery\u2013alone group. With one-to-many propensity score matching, 76 versus 37 cases were compared for open surgery alone versus adjunctive MMAE following open surgery. Similarly, the adjunctive MMAE group had significantly lower rates of recurrence (5.4% vs 19.7%, p = 0.037) and overall reintervention (2.7% vs 14.5%, p = 0.049).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Adjunctive MMAE following open surgery can lower the recurrence risks and reintervention rates for cSDH.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.11.jns222024","type":"journal-article","created":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T11:16:36Z","timestamp":1671794196000},"page":"124-130","source":"Crossref","is-referenced-by-count":30,"title":["Reduced recurrence of chronic subdural hematomas treated with open surgery followed by middle meningeal artery embolization compared to open surgery alone: a propensity score\u2013matched analysis"],"prefix":"10.3171","volume":"139","author":[{"given":"Mira","family":"Salih","sequence":"first","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Shutran","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Young","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael A.","family":"Vega","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Stippler","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efstathios","family":"Papavassiliou","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron L.","family":"Alterman","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajith","family":"Thomas","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Taussky","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Moore","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher S.","family":"Ogilvy","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Neurosurg Clin N Am","first-page":"205","article-title":"Chronic subdural hematoma: epidemiology and natural history","volume":"28","author":"Yang W","year":"2017","unstructured":"Yang W, Huang J. Chronic subdural hematoma: epidemiology and natural history. Neurosurg Clin N Am. 2017;28(2):205\u2013210.28325454"},{"issue":"5","key":"b2","series-title":"J Neurosurg","first-page":"1209","article-title":"Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations","volume":"123","author":"Balser D","year":"2015","unstructured":"Balser D, Farooq S, Mehmood T, Reyes M, Samadani U. Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations. J Neurosurg. 2015;123(5):1209\u20131215.25794342"},{"issue":"4","key":"b3","series-title":"J Neurosurg","first-page":"1208","article-title":"A propensity-adjusted comparison of middle meningeal artery embolization versus conventional therapy for chronic subdural hematomas","volume":"135","author":"Catapano JS","year":"2021","unstructured":"Catapano JS, Ducruet AF, Nguyen CL,  A propensity-adjusted comparison of middle meningeal artery embolization versus conventional therapy for chronic subdural hematomas. J Neurosurg. 2021;135(4):1208\u20131213.33636706"},{"issue":"3","key":"b4","series-title":"Neurosurgery","first-page":"486","article-title":"Middle meningeal artery embolization versus conventional treatment of chronic subdural hematomas","volume":"89","author":"Enriquez-Marulanda A","year":"2021","unstructured":"Enriquez-Marulanda A, Gomez-Paz S, Salem MM,  Middle meningeal artery embolization versus conventional treatment of chronic subdural hematomas. Neurosurgery. 2021;89(3):486\u2013495.34171921"},{"key":"b5","series-title":"World Neurosurg","first-page":"520","article-title":"Embolization therapy for refractory hemorrhage in patients with chronic subdural hematomas","volume":"101","author":"Kim E","year":"2017","unstructured":"Kim E. Embolization therapy for refractory hemorrhage in patients with chronic subdural hematomas. World Neurosurg. 2017;101:520\u2013527.28249828"},{"issue":"3","key":"b6","series-title":"J Neurointerv Surg","first-page":"297","article-title":"Efficacy and mid-term outcome of middle meningeal artery embolization with or without burr hole evacuation for chronic subdural hematoma compared with burr hole evacuation alone","volume":"14","author":"Onyinzo C","year":"2022","unstructured":"Onyinzo C, Berlis A, Abel M, Kudernatsch M, Maurer CJ. Efficacy and mid-term outcome of middle meningeal artery embolization with or without burr hole evacuation for chronic subdural hematoma compared with burr hole evacuation alone. J Neurointerv Surg. 2022;14(3):297\u2013300."},{"issue":"12","key":"b7","series-title":"J Neurointerv Surg","first-page":"1209","article-title":"Middle meningeal artery embolization reduces the post-operative recurrence rate of at-risk chronic subdural hematoma","volume":"12","author":"Shotar E","year":"2020","unstructured":"Shotar E, Meyblum L, Premat K,  Middle meningeal artery embolization reduces the post-operative recurrence rate of at-risk chronic subdural hematoma. J Neurointerv Surg. 2020;12(12):1209\u20131213.32439812"},{"issue":"7","key":"b8","series-title":"J Neurointerv Surg","first-page":"695","article-title":"Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption","volume":"12","author":"Ng S","year":"2020","unstructured":"Ng S, Derraz I, Boetto J,  Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption. J Neurointerv Surg. 2020;12(7):695\u2013699.31862830"},{"issue":"1","key":"b9","series-title":"Clin Spine Surg","first-page":"22","article-title":"Propensity score matching: a powerful tool for analyzing observational nonrandomized data","volume":"34","author":"Badhiwala JH","year":"2021","unstructured":"Badhiwala JH, Karmur BS, Wilson JR. Propensity score matching: a powerful tool for analyzing observational nonrandomized data. Clin Spine Surg. 2021;34(1):22\u201324.32804684"},{"issue":"9695","key":"b10","series-title":"Lancet","first-page":"1067","article-title":"Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial","volume":"374","author":"Santarius T","year":"2009","unstructured":"Santarius T, Kirkpatrick PJ, Ganesan D,  Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet. 2009;374(9695):1067\u20131073.19782872"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/139\/1\/article-p124.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/139\/1\/article-p124.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/139\/1\/article-p124.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T10:46:54Z","timestamp":1716029214000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/139\/1\/article-p124.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,1]]},"references-count":10,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2022.11.jns222024","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,1]]}}}