International multi-center study of middle meningeal artery embolization for chronic subdural hematoma in cancer patients: Efficacy, safety, and outcomes in a high-risk population

Avi A Gajjar^{1

2}, Mohamed M Salem^{1

3}, Georgios S Sioutas¹, Rashad Jabarkheel¹, Okkes Kuybu⁴, Jane Khalife⁵, Daniel A Tonetti⁵, Gustavo Cortez⁶, Adam A Dmytriw^{7

8}, Diego Alejandro Ortega Moreno⁸, William Smith⁷, Robert W Regenhardt⁷, Kate T Carroll⁹, Zachary A Abecassis⁹, Juan Francisco Ruiz Rodriguez⁹, Oleg Shekhtman¹, Alex Nguyen Hoang¹⁰, Alexander A Khalessi¹¹, Cordell Baker¹², Matthias Matejka¹³, Nicole M Cancelliere⁸, Christoph J Griessenauer¹³, Ramesh Grandhi¹², Peter Kan^{10

14}, Omar Tanweer¹⁰, Michael R Levitt⁹, Christopher J Stapleton⁷, Vitor Mendes Pereira⁸, Brian Jankowitz^{1

15}, Howard A Riina¹⁶, Aman B Patel⁷, Ricardo Hanel⁶, Ajith J Thomas⁵, Michael J Lang⁴, Bradley A Gross⁴, Jan-Karl Burkhardt¹, Visish M Srinivasan¹

Affiliations

¹ Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
² Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
³ Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
⁴ Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁵ Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA.
⁶ Department of Cerebrovascular and Endovascular Surgery, Baptist Neurological Institute and Lyerly Neurosurgery, Jacksonville, Florida, USA.
⁷ Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, USA.
⁸ Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St Michael's Hospital, University of Toronto, Toronto, ON, USA.
⁹ Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
¹⁰ Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
¹¹ Department of Neurosurgery, University of California-San Diego, La Jolla, California, USA.
¹² Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA.
¹³ Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
¹⁴ Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA.
¹⁵ Department of Neurosurgery, JFK New Jersey Neuroscience Institute, Edison, New Jersey, USA.
¹⁶ Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA.

PMID: 40356457
PMCID: PMC12075151
DOI: 10.1177/15910199251341650

International multi-center study of middle meningeal artery embolization for chronic subdural hematoma in cancer patients: Efficacy, safety, and outcomes in a high-risk population

Avi A Gajjar et al. Interv Neuroradiol. 2025.

. 2025 May 13:15910199251341650.

doi: 10.1177/15910199251341650. Online ahead of print.

Authors

Affiliations

¹ Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
² Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
³ Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
⁴ Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁵ Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA.
⁶ Department of Cerebrovascular and Endovascular Surgery, Baptist Neurological Institute and Lyerly Neurosurgery, Jacksonville, Florida, USA.
⁷ Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, USA.
⁸ Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St Michael's Hospital, University of Toronto, Toronto, ON, USA.
⁹ Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
¹⁰ Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
¹¹ Department of Neurosurgery, University of California-San Diego, La Jolla, California, USA.
¹² Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA.
¹³ Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
¹⁴ Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA.
¹⁵ Department of Neurosurgery, JFK New Jersey Neuroscience Institute, Edison, New Jersey, USA.
¹⁶ Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA.

PMID: 40356457
PMCID: PMC12075151
DOI: 10.1177/15910199251341650

Abstract

BackgroundMiddle meningeal artery embolization (MMAE) is a promising treatment for chronic subdural hematoma (cSDH). Cancer patients are at risk for cSDH due to thrombocytopenia. The efficacy of MMAE in this population has not been studied.MethodsWe conducted a retrospective analysis of 76 patients who underwent 94 MMAEs for cSDH at 12 tertiary centers across North America and Europe between February 2018 and January 2023. We analyzed patient demographics, clinical profiles, procedural details, and outcomes. The primary outcome was cSDH progression, while secondary outcomes included radiographic resolution, mortality, 90-day functional outcomes, functional improvement, and procedural complications.ResultsRadiographic improvement occurred in 88.5% of patients, and technical success was achieved in 96.8%, with comparable rates between the MMAE-only and MMAE + surgery groups. Complications occurred in five patients (5.3%), with no significant difference between groups (6.0% in MMAE vs. 3.7% in MMAE + surgery, p = 0.658). Hemorrhage was reported in four patients (4.3%), and no cases of stroke were recorded. Mortality was 24.5% overall, with a slightly higher rate in the MMAE + surgery group (29.6%) compared to the MMAE-only group (22.4%, p = 0.460). Functional improvement in modified Rankin Scale (mRS) was seen in 15 patients (24.2%), with a significantly greater improvement in the combined group (Δ mRS = 2.625) versus the MMAE-only group (Δ mRS = 0.348, p < 0.001).ConclusionsMMAE is a safe and effective treatment option for managing cSDH in cancer patients. Higher mortality in this population is likely reflective of underlying cancer and comorbidities.

Keywords: MMAE; Middle meningeal artery embolization; cSDH; cancer; chronic subdural hematoma; thrombocytopenia.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

**Figure 1.**
Kaplan–Meier curve of mortality by MMAE vs. MMAE + surgery for patients with cancer.

See this image and copyright information in PMC

References

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International multi-center study of middle meningeal artery embolization for chronic subdural hematoma in cancer patients: Efficacy, safety, and outcomes in a high-risk population

Affiliations

International multi-center study of middle meningeal artery embolization for chronic subdural hematoma in cancer patients: Efficacy, safety, and outcomes in a high-risk population

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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