{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T01:00:53Z","timestamp":1784682053827,"version":"3.55.0"},"reference-count":14,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,7,20]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Middle meningeal artery (MMA) embolization is a minimally invasive treatment for chronic subdural hematoma (CSDH) that reduces recurrence by interrupting the vascular supply to the outer membrane; however, the mechanisms underlying recurrence remain incompletely understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>\n                      An 80-year-old man with recurrent CSDH after burr hole evacuation underwent MMA embolization. The anterior convexity branch, identified as the principal feeder, was successfully embolized using 20%\n                      <jats:italic>n<\/jats:italic>\n                      -butyl-2-cyanoacrylate (NBCA). The posterior convexity branch did not demonstrate membrane staining, and embolization was therefore concluded. Despite initial improvement, recurrence required craniotomy. Intraoperative indocyanine green angiography demonstrated no flow in the embolized territory, whereas preserved and newly developed blood flow was observed in the nonembolized territory. Histopathological examination revealed preserved vascular structures with abundant neovascularization in the nonembolized region. In contrast, the embolized region showed reticular NBCA casts within MMA branches and penetrating vessels, accompanied by endothelial desquamation, medial thinning, and mild lymphocytic infiltration. NBCA fragments were also identified within the outer membrane, associated with foreign body reactions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Recurrence may result from collateral flow from nonembolized MMA branches, even after technically successful embolization. Histological findings support NBCA penetration into the outer membrane and highlight the importance of tailored and potentially more comprehensive embolization strategies.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE26423\">https:\/\/thejns.org\/doi\/10.3171\/CASE26423<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26423","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:01:05Z","timestamp":1784678465000},"source":"Crossref","is-referenced-by-count":0,"title":["Intraindividual histopathological comparison of embolized and nonembolized territories in recurrent chronic subdural hematoma after middle meningeal artery embolization: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"given":"Shunichiro","family":"Saiki","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Hokkaido"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9006-3835","authenticated-orcid":true,"given":"Yasuyuki","family":"Tatsuta","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Hokkaido"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9682-9328","authenticated-orcid":true,"given":"Koki","family":"Ise","sequence":"additional","affiliation":[{"name":"Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Okuma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Hokkaido"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiaki","family":"Osato","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Hokkaido"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3474-2646","authenticated-orcid":true,"given":"Zen-ichi","family":"Tanei","sequence":"additional","affiliation":[{"name":"Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirohiko","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Hokkaido"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"Brain Spine","first-page":"100300","article-title":"Chronic Subdural Hematoma (cSDH): a review of the current state of the art","volume":"1","author":"Nouri","year":"2021","unstructured":"Nouri AGondar RSchaller KMeling T.Chronic Subdural Hematoma (cSDH): a review of the current state of the art. Brain Spine. 2021;1:100300. doi:10.1016\/j.bas.2021.100300"},{"key":"bib2","series-title":"World Neurosurg","first-page":"399","article-title":"Surgical treatments for chronic subdural hematomas: a comprehensive systematic review","volume":"86","author":"Ivamoto","year":"2016","unstructured":"Ivamoto HSLemos HPAtallah AN.Surgical treatments for chronic subdural hematomas: a comprehensive systematic review. World Neurosurg. 2016;86:399-418. doi:10.1016\/j.wneu.2015.10.025"},{"issue":"6","key":"bib3","series-title":"Oper Neurosurg","first-page":"817","article-title":"Middle meningeal artery embolization for chronic subdural hematoma using n-butyl cyanoacrylate with a D5W push technique: a multicentric North American study of 269 patients","volume":"28","author":"Abdelsalam","year":"2025","unstructured":"Abdelsalam ARamsay IALuther EMMiddle meningeal artery embolization for chronic subdural hematoma using n-butyl cyanoacrylate with a D5W push technique: a multicentric North American study of 269 patients. Oper Neurosurg. 2025;28(6):817-823. doi:10.1227\/ons.0000000000001369"},{"issue":"20","key":"bib4","series-title":"N Engl J Med","first-page":"1890","article-title":"Adjunctive middle meningeal artery embolization for subdural hematoma","volume":"391","author":"Davies","year":"2024","unstructured":"Davies JMKnopman JMokin MAdjunctive middle meningeal artery embolization for subdural hematoma. N Engl J Med. 2024;391(20):1890-1900. doi:10.1056\/NEJMoa2313472"},{"issue":"9","key":"bib5","series-title":"N Engl J Med","first-page":"855","article-title":"Embolization of the middle meningeal artery for chronic subdural hematoma","volume":"392","author":"Fiorella","year":"2025","unstructured":"Fiorella DMonteith SJHanel REmbolization of the middle meningeal artery for chronic subdural hematoma. N Engl J Med. 2025;392(9):855-864. doi:10.1056\/NEJMoa2409845"},{"issue":"20","key":"bib6","series-title":"N Engl J Med","first-page":"1901","article-title":"Middle meningeal artery embolization for nonacute subdural hematoma","volume":"391","author":"Liu","year":"2024","unstructured":"Liu JNi WZuo QMiddle meningeal artery embolization for nonacute subdural hematoma. N Engl J Med. 2024;391(20):1901-1912. doi:10.1056\/NEJMoa2401201"},{"key":"bib7","series-title":"Clin Neurol Neurosurg","first-page":"109128","article-title":"Middle meningeal artery embolisation reduces chronic subdural haematoma recurrence: a meta-analysis of EMBOLISE, STEM, MAGIC-MT and EMPROTECT trials and cost analysis","volume":"258","author":"Jayakumar","year":"2025","unstructured":"Jayakumar NKennion OCoulter I.Middle meningeal artery embolisation reduces chronic subdural haematoma recurrence: a meta-analysis of EMBOLISE, STEM, MAGIC-MT and EMPROTECT trials and cost analysis. Clin Neurol Neurosurg. 2025;258:109128. doi:10.1016\/j.clineuro.2025.109128"},{"issue":"4","key":"bib8","series-title":"Radiology","first-page":"e222045","article-title":"Middle meningeal artery embolization for chronic subdural hematoma: predictors of clinical and radiographic failure from 636 embolizations","volume":"307","author":"Salem","year":"2023","unstructured":"Salem MMKuybu ONguyen Hoang ANMiddle meningeal artery embolization for chronic subdural hematoma: predictors of clinical and radiographic failure from 636 embolizations. Radiology. 2023;307(4):e222045. doi:10.1148\/radiol.222045"},{"issue":"1","key":"bib9","series-title":"J Neuroinflammation","first-page":"108","article-title":"Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy","volume":"14","author":"Edlmann","year":"2017","unstructured":"Edlmann EGiorgi-Coll SWhitfield PCCarpenter KLHHutchinson PJ.Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation. 2017;14(1):108. doi:10.1186\/s12974-017-0881-y"},{"key":"bib10","series-title":"World Neurosurg","first-page":"339","article-title":"Updates in chronic subdural hematoma: epidemiology, etiology, pathogenesis, treatment, and outcome","volume":"141","author":"Feghali","year":"2020","unstructured":"Feghali JYang WHuang J.Updates in chronic subdural hematoma: epidemiology, etiology, pathogenesis, treatment, and outcome. World Neurosurg. 2020;141:339-345. doi:10.1016\/j.wneu.2020.06.140"},{"issue":"10","key":"bib11","series-title":"J Clin Neurosci","first-page":"1398","article-title":"Histopathological features of the outer membrane of chronic subdural hematoma and correlation with clinical and radiological features","volume":"20","author":"Gandhoke","year":"2013","unstructured":"Gandhoke GSKaif MChoi LWilliamson RWNakaji P.Histopathological features of the outer membrane of chronic subdural hematoma and correlation with clinical and radiological features. 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Neurosurg Rev. 2023;46(1):270. doi:10.1007\/s10143-023-02175-1"},{"key":"bib14","series-title":"J Clin Neurosci","first-page":"79","article-title":"Influence of antithrombotic agents on the recurrence of chronic subdural hematomas and the quest about the recommencement of antithrombotic agents: a \u00admeta-analysis","volume":"38","author":"Wang","year":"2017","unstructured":"Wang YZhou JFan CInfluence of antithrombotic agents on the recurrence of chronic subdural hematomas and the quest about the recommencement of antithrombotic agents: a \u00admeta-analysis. J Clin Neurosci. 2017;38:79-83. doi:10.1016\/j.jocn.2016.12.001"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/3\/article-CASE26423.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/3\/article-CASE26423.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/3\/article-CASE26423.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:01:06Z","timestamp":1784678466000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/3\/article-CASE26423.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":14,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/case26423","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]}}}