{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:18:06Z","timestamp":1790381886552,"version":"4.1.0"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Chronic subdural hematoma (cSDH) recurrence is a significant cause of morbidity in neurosurgical patients. Middle meningeal artery embolization (MMAe) effectively reduces cSDH recurrence by targeting its associated inflammatory cascade. Delayed recanalization can occur from proximal branches of the middle meningeal artery (MMA) after use of particle embolic agents. Surgeons may utilize coil embolization in addition to particle embolic agents to achieve proximal vessel control. This study compares reaccumulation rates for cSDH patients undergoing particle embolization of the MMA with and without coil embolization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective review of prospectively collected data was performed on the records of patients who underwent particle MMAe with or without coils for cSDH at the authors\u2019 institution from 2021 to 2023 The primary outcome was cSDH recurrence at CT follow-up at least 1 month after MMAe.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Sixty-two patients underwent 81 embolization procedures with particles alone (n = 32) or particles and coils (n = 49). There was no significant difference in recurrence between particles versus particles and coils (6.3% vs 10.2%, p = 0.698). There was a statistical difference in procedure length (54.8 \u00b1 28.7 vs 85.9 \u00b1 26.5 minutes, p &lt; 0.001) and fluoroscopy time (34.9 \u00b1 20.8 vs 48.8 \u00b1 24.7 minutes, p = 0.01) between patients who underwent particle embolization versus those who underwent embolization with particles and coils. A noninferiority analysis demonstrated no significant difference between groups in treatment failure, hematoma expansion, and follow-up size &gt; 1 cm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>In the setting of cSDH, MMAe using particles only versus particles with coils shows similar rates of hematoma reaccumulation and resolution. Procedural time and fluoroscopy time were significantly reduced within the particle embolization\u2013alone cohort. When comparing hematoma resolution and expansion, follow-up hematoma size &gt; 1 cm, and decrease in hematoma size &gt; 1 cm between groups, embolization using particles alone was not inferior to embolization using particles supplemented with coils.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.3.jns242385","type":"journal-article","created":{"date-parts":[[2025,7,26]],"date-time":"2025-07-26T01:29:49Z","timestamp":1753493389000},"page":"1539-1544","source":"Crossref","is-referenced-by-count":6,"title":["Comparison of clinical and radiological outcomes using solely particles versus particles with coils in middle meningeal artery embolization for chronic subdural hematoma: a longitudinal comparative cohort study"],"prefix":"10.3171","volume":"143","author":[{"given":"Jeffrey","family":"Turnbull","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Caskey","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ammar","family":"Alsalahi","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel W.","family":"Griepp","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivum","family":"Desai","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boyd","family":"Richards","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashant","family":"Kelkar","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad F.","family":"Claus","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius","family":"Griauzde","sequence":"additional","affiliation":[{"name":"Interventional Radiology, Henry Ford Providence Hospital, Southfield, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","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."},{"issue":"5","key":"b2","series-title":"J Neurointerv Surg","first-page":"471","article-title":"Neuroanatomy of cranial dural vessels: implications for subdural hematoma embolization","volume":"13","author":"Shapiro M","year":"2021","unstructured":"Shapiro M, Walker M, Carroll KT,  Neuroanatomy of cranial dural vessels: implications for subdural hematoma embolization. J Neurointerv Surg. 2021;13(5):471\u2013477."},{"issue":"4","key":"b3","series-title":"J Neurosurg","first-page":"732","article-title":"The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom","volume":"127","author":"Brennan PM","year":"2017","unstructured":"Brennan PM, Kolias AG, Joannides AJ,  The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom. J Neurosurg. 2017;127(4):732\u2013739."},{"issue":"7","key":"b4","series-title":"J Neurointerv Surg","first-page":"657","article-title":"Middle meningeal artery embolization for chronic subdural hematoma: an institutional technical analysis","volume":"13","author":"Catapano JS","year":"2021","unstructured":"Catapano JS, Ducruet AF, Nguyen CL,  Middle meningeal artery embolization for chronic subdural hematoma: an institutional technical analysis. J Neurointerv Surg. 2021;13(7):657\u2013660."},{"issue":"6","key":"b5","series-title":"Neurosurgery","first-page":"1142","article-title":"Middle meningeal artery embolization versus conventional management for patients with chronic subdural hematoma: a systematic review and meta-analysis","volume":"92","author":"Sattari SA","year":"2023","unstructured":"Sattari SA, Yang W, Shahbandi A,  Middle meningeal artery embolization versus conventional management for patients with chronic subdural hematoma: a systematic review and meta-analysis. Neurosurgery. 2023;92(6):1142\u20131154."},{"issue":"3","key":"b6","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."},{"issue":"3","key":"b7","series-title":"AJNR Am J Neuroradiol","first-page":"297","article-title":"Embolic agent choice in middle meningeal artery embolization as primary or adjunct treatment for chronic subdural hematoma: a systematic review and meta-analysis","volume":"44","author":"Ku JC","year":"2023","unstructured":"Ku JC, Dmytriw AA, Essibayi MA,  Embolic agent choice in middle meningeal artery embolization as primary or adjunct treatment for chronic subdural hematoma: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2023;44(3):297\u2013302."},{"issue":"1","key":"b8","series-title":"Stroke Vasc Interv Neurol","first-page":"000906","article-title":"Middle meningeal artery embolization for chronic subdural hematoma: a review of established and emerging embolic agents","volume":"4","author":"Tudor T","year":"2024","unstructured":"Tudor T, Capone S, Vivanco-Suarez J,  Middle meningeal artery embolization for chronic subdural hematoma: a review of established and emerging embolic agents. Stroke Vasc Interv Neurol. 2024;4(1):000906."},{"key":"b9","article-title":"EMBOLISE: Embolization of the MMA with Onyx Liquid Embolic System in the treatment of subacute and chronic subdural hematoma","author":"Michael J","unstructured":"Michael J, Davies M. EMBOLISE: Embolization of the MMA with Onyx Liquid Embolic System in the treatment of subacute and chronic subdural hematoma. Paper presented at: International Stroke Conference; February 7, 2024; Phoenix, AZ."},{"issue":"3","key":"b10","series-title":"Semin Intervent Radiol","first-page":"204","article-title":"An overview of embolic agents","volume":"25","author":"Vaidya S","year":"2008","unstructured":"Vaidya S, Tozer K, Chen J. An overview of embolic agents. Semin Intervent Radiol. 2008;25(3):204\u2013215."},{"issue":"3","key":"b11","series-title":"J Neurosurg","first-page":"665","article-title":"Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures: a systematic review","volume":"121","author":"Liu W","year":"2014","unstructured":"Liu W, Bakker NA, Groen RJM. Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures: a systematic review. J Neurosurg. 2014;121(3):665\u2013673."},{"issue":"4","key":"b12","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases","volume":"49","author":"Joyce E","year":"2020","unstructured":"Joyce E, Bounajem MT, Scoville J,  Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases. Neurosurg Focus. 2020;49(4):E5."},{"issue":"2","key":"b13","series-title":"Diagnostics (Basel)","first-page":"257","article-title":"Recurrence and coniglobus volumetric resolution of subacute and chronic subdural hematoma post-middle meningeal artery embolization","volume":"11","author":"Tiwari A","year":"2021","unstructured":"Tiwari A, Dmytriw AA, Bo R,  Recurrence and coniglobus volumetric resolution of subacute and chronic subdural hematoma post-middle meningeal artery embolization. Diagnostics (Basel). 2021;11(2):257."},{"key":"b14","series-title":"Published online December","article-title":"Coil embolization alone appears sufficient for middle meningeal artery embolization. Interv Neuroradiol","volume":"11,","author":"Iyer AM","year":"2023","unstructured":"Iyer AM, Venkataraman SS, Kittel CA, Fargen KM. Coil embolization alone appears sufficient for middle meningeal artery embolization. Interv Neuroradiol. Published online December 11,2023. doi:10.1177\/15910199231217144"},{"issue":"5","key":"b1","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."},{"issue":"5","key":"b2","series-title":"J Neurointerv Surg","first-page":"471","article-title":"Neuroanatomy of cranial dural vessels: implications for subdural hematoma embolization","volume":"13","author":"Shapiro M","year":"2021","unstructured":"Shapiro M, Walker M, Carroll KT,  Neuroanatomy of cranial dural vessels: implications for subdural hematoma embolization. J Neurointerv Surg. 2021;13(5):471\u2013477."},{"issue":"4","key":"b3","series-title":"J Neurosurg","first-page":"732","article-title":"The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom","volume":"127","author":"Brennan PM","year":"2017","unstructured":"Brennan PM, Kolias AG, Joannides AJ,  The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom. J Neurosurg. 2017;127(4):732\u2013739."},{"issue":"7","key":"b4","series-title":"J Neurointerv Surg","first-page":"657","article-title":"Middle meningeal artery embolization for chronic subdural hematoma: an institutional technical analysis","volume":"13","author":"Catapano JS","year":"2021","unstructured":"Catapano JS, Ducruet AF, Nguyen CL,  Middle meningeal artery embolization for chronic subdural hematoma: an institutional technical analysis. J Neurointerv Surg. 2021;13(7):657\u2013660."},{"issue":"6","key":"b5","series-title":"Neurosurgery","first-page":"1142","article-title":"Middle meningeal artery embolization versus conventional management for patients with chronic subdural hematoma: a systematic review and meta-analysis","volume":"92","author":"Sattari SA","year":"2023","unstructured":"Sattari SA, Yang W, Shahbandi A,  Middle meningeal artery embolization versus conventional management for patients with chronic subdural hematoma: a systematic review and meta-analysis. Neurosurgery. 2023;92(6):1142\u20131154."},{"issue":"3","key":"b6","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."},{"issue":"3","key":"b7","series-title":"AJNR Am J Neuroradiol","first-page":"297","article-title":"Embolic agent choice in middle meningeal artery embolization as primary or adjunct treatment for chronic subdural hematoma: a systematic review and meta-analysis","volume":"44","author":"Ku JC","year":"2023","unstructured":"Ku JC, Dmytriw AA, Essibayi MA,  Embolic agent choice in middle meningeal artery embolization as primary or adjunct treatment for chronic subdural hematoma: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2023;44(3):297\u2013302."},{"issue":"1","key":"b8","series-title":"Stroke Vasc Interv Neurol","first-page":"000906","article-title":"Middle meningeal artery embolization for chronic subdural hematoma: a review of established and emerging embolic agents","volume":"4","author":"Tudor T","year":"2024","unstructured":"Tudor T, Capone S, Vivanco-Suarez J,  Middle meningeal artery embolization for chronic subdural hematoma: a review of established and emerging embolic agents. Stroke Vasc Interv Neurol. 2024;4(1):000906."},{"key":"b9","article-title":"EMBOLISE: Embolization of the MMA with Onyx Liquid Embolic System in the treatment of subacute and chronic subdural hematoma","author":"Michael J","unstructured":"Michael J, Davies M. EMBOLISE: Embolization of the MMA with Onyx Liquid Embolic System in the treatment of subacute and chronic subdural hematoma. Paper presented at: International Stroke Conference; February 7, 2024; Phoenix, AZ."},{"issue":"3","key":"b10","series-title":"Semin Intervent Radiol","first-page":"204","article-title":"An overview of embolic agents","volume":"25","author":"Vaidya S","year":"2008","unstructured":"Vaidya S, Tozer K, Chen J. An overview of embolic agents. Semin Intervent Radiol. 2008;25(3):204\u2013215."},{"issue":"3","key":"b11","series-title":"J Neurosurg","first-page":"665","article-title":"Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures: a systematic review","volume":"121","author":"Liu W","year":"2014","unstructured":"Liu W, Bakker NA, Groen RJM. Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures: a systematic review. J Neurosurg. 2014;121(3):665\u2013673."},{"issue":"4","key":"b12","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases","volume":"49","author":"Joyce E","year":"2020","unstructured":"Joyce E, Bounajem MT, Scoville J,  Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases. Neurosurg Focus. 2020;49(4):E5."},{"issue":"2","key":"b13","series-title":"Diagnostics (Basel)","first-page":"257","article-title":"Recurrence and coniglobus volumetric resolution of subacute and chronic subdural hematoma post-middle meningeal artery embolization","volume":"11","author":"Tiwari A","year":"2021","unstructured":"Tiwari A, Dmytriw AA, Bo R,  Recurrence and coniglobus volumetric resolution of subacute and chronic subdural hematoma post-middle meningeal artery embolization. Diagnostics (Basel). 2021;11(2):257."},{"key":"b14","series-title":"Published online December","article-title":"Coil embolization alone appears sufficient for middle meningeal artery embolization. Interv Neuroradiol","volume":"11,","author":"Iyer AM","year":"2023","unstructured":"Iyer AM, Venkataraman SS, Kittel CA, Fargen KM. Coil embolization alone appears sufficient for middle meningeal artery embolization. Interv Neuroradiol. 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