Middle Meningeal Artery Embolization for the Treatment of Chronic Subdural Hematomas-a German Nationwide Multi-center Study On 718 Embolizations

Dominik F Vollherbst¹, Ansgar Berlis², Mahmoud Zaki², Christoph Maurer^{2

3}, Christina Onyinzo⁴, Fee C Keil⁵, Leonard Mann⁵, Christophe T Arendt⁵, Marius Hartmann^{6

7}, Steffen Reißberg⁶, Corinna Rutschke⁶, Kai Kallenberg⁸, Stefan Grau⁹, Alexandru Durutya⁸, Adrian Liebert¹⁰, Heinz L Voit-Höhne¹¹, Markus Holtmannspötter¹¹, Christian Herweh^{12

13}, René Chapot¹⁴, Mohamed Elsharkawy¹⁴, Dan Meila¹⁵, Björn Greling¹⁵, Frederik Boxberg¹⁶, Dominik Grieb^{16

17}, Cornelius Deuschl¹⁸, Yahya Ahmadipour¹⁹, Tobias Boeckh-Behrens²⁰, Jannis Bodden²⁰, Carsten Lukas²¹, Felix Kämmerer²¹, Daniel Behme²², Elie Diamandis^{22

23}, Eberhard Siebert²⁴, Aymen Meddeb²⁴, Kornelia Kreiser²⁵, Sabine Heinz²⁵, Stephan Meckel^{26

27}, Semin Berzeg-Kolck²⁶, Jens Fiehler²⁸, Matthias Bechstein²⁸, Marius G Kaschner²⁹, Keihan Darvishi²⁹, Laura S Leukert³⁰, Marc A Brockmann³⁰, Thomas E Mayer³¹, Jan-Hendrik Buhk³², Charlotte S Weyland³³, Lukas Görtz³⁴, Christoph Kabbasch³⁴, Werner Weber³⁵, Christina Wendl^{36

37}, Tobias Struffert³⁸, Christian Dyzmann³⁹, Johannes C Gerber⁴⁰, Martin Bendszus¹², Markus A Möhlenbruch¹²

Affiliations

¹ Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany. dominik.vollherbst@med.uni-heidelberg.de.
² Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany.
³ Neuroradiology, Schön Klinik Vogtareuth, Vogtareuth, Germany.
⁴ Neurosurgery, Schön Klinik Vogtareuth, Vogtareuth, Germany.
⁵ Institute of Neuroradiology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany.
⁶ Institut für Neuroradiologie, Helios Klinikum Berlin-Buch, Berlin, Germany.
⁷ Institut für Radiologie, Neuroradiologie und Nuklearmedizin, Klinikum Darmstadt, Darmstadt, Germany.
⁸ Department of Neuroradiology, Klinikum Fulda, Fulda, Germany.
⁹ Clinic for Neurosurgery, Klinikum Fulda, Fulda, Germany.
¹⁰ Department of Neurosurgery, Paracelsus Medical University, Nuremberg, Germany.
¹¹ Department of Neuroradiology, Paracelsus Medical University, Nuremberg, Germany.
¹² Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany.
¹³ Department of Neuroradiology, Klinikum Frankfurt Höchst, Frankfurt, Germany.
¹⁴ Neuroradiology, Alfried-Krupp-Krankenhaus Rüttenscheid, Essen, Germany.
¹⁵ Department of Interventional Neuroradiology, Johanna-Etienne-Hospital, Neuss, Germany.
¹⁶ Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany.
¹⁷ Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany.
¹⁸ Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Medicine Essen, University of Duisburg-Essen, Essen, Germany.
¹⁹ Department of Neurosurgery and Spine Surgery, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, University Duisburg-Essen, Essen, Germany.
²⁰ School of Medicine and Health, Institute for Neuroradiology, TUM University Hospital, Technical University of Munich, Munich, Germany.
²¹ Institute of Neuroradiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany.
²² Clinic for Neuroradiology, University Medical Center Magdeburg, Magdeburg, Germany.
²³ Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany.
²⁴ Institute of Neuroradiology, Charité, Universitätsmedizin Berlin, Berlin, Germany.
²⁵ Department of Neuroradiology, University of Ulm, Ulm, Germany.
²⁶ Institute of Diagnostic and Interventional Neuroradiology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany.
²⁷ Department of Neuroradiology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.
²⁸ Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
²⁹ Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany.
³⁰ Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany.
³¹ Sektion Neuroradiologie, Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum Jena, Jena, Germany.
³² Neuroradiology, Asklepios Klinik St. Georg, Hamburg, Germany.
³³ Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany.
³⁴ Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
³⁵ Institut für Diagnostische Radiologie, Neuroradiologie und Nuklearmedizin, Knappschaft Kliniken, Universitätsklinikum Bochum, Bochum, Germany.
³⁶ Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
³⁷ Center of Neuroradiology, medbo District Hospital and University Medical Center Regensburg, Regensburg, Germany.
³⁸ Department of Neuroradiology, University Hospital Giessen, Giessen, Germany.
³⁹ Neuroradiology Department, Sana Kliniken, Lübeck, Germany.
⁴⁰ Institute of Neuroradiology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany.

PMID: 40824387
DOI: 10.1007/s00062-025-01549-w

Middle Meningeal Artery Embolization for the Treatment of Chronic Subdural Hematomas-a German Nationwide Multi-center Study On 718 Embolizations

Dominik F Vollherbst et al. Clin Neuroradiol. 2025.

. 2025 Aug 18.

doi: 10.1007/s00062-025-01549-w. Online ahead of print.

Authors

Affiliations

¹ Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany. dominik.vollherbst@med.uni-heidelberg.de.
² Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany.
³ Neuroradiology, Schön Klinik Vogtareuth, Vogtareuth, Germany.
⁴ Neurosurgery, Schön Klinik Vogtareuth, Vogtareuth, Germany.
⁵ Institute of Neuroradiology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany.
⁶ Institut für Neuroradiologie, Helios Klinikum Berlin-Buch, Berlin, Germany.
⁷ Institut für Radiologie, Neuroradiologie und Nuklearmedizin, Klinikum Darmstadt, Darmstadt, Germany.
⁸ Department of Neuroradiology, Klinikum Fulda, Fulda, Germany.
⁹ Clinic for Neurosurgery, Klinikum Fulda, Fulda, Germany.
¹⁰ Department of Neurosurgery, Paracelsus Medical University, Nuremberg, Germany.
¹¹ Department of Neuroradiology, Paracelsus Medical University, Nuremberg, Germany.
¹² Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany.
¹³ Department of Neuroradiology, Klinikum Frankfurt Höchst, Frankfurt, Germany.
¹⁴ Neuroradiology, Alfried-Krupp-Krankenhaus Rüttenscheid, Essen, Germany.
¹⁵ Department of Interventional Neuroradiology, Johanna-Etienne-Hospital, Neuss, Germany.
¹⁶ Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany.
¹⁷ Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany.
¹⁸ Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Medicine Essen, University of Duisburg-Essen, Essen, Germany.
¹⁹ Department of Neurosurgery and Spine Surgery, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, University Duisburg-Essen, Essen, Germany.
²⁰ School of Medicine and Health, Institute for Neuroradiology, TUM University Hospital, Technical University of Munich, Munich, Germany.
²¹ Institute of Neuroradiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany.
²² Clinic for Neuroradiology, University Medical Center Magdeburg, Magdeburg, Germany.
²³ Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany.
²⁴ Institute of Neuroradiology, Charité, Universitätsmedizin Berlin, Berlin, Germany.
²⁵ Department of Neuroradiology, University of Ulm, Ulm, Germany.
²⁶ Institute of Diagnostic and Interventional Neuroradiology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany.
²⁷ Department of Neuroradiology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.
²⁸ Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
²⁹ Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany.
³⁰ Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany.
³¹ Sektion Neuroradiologie, Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum Jena, Jena, Germany.
³² Neuroradiology, Asklepios Klinik St. Georg, Hamburg, Germany.
³³ Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany.
³⁴ Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
³⁵ Institut für Diagnostische Radiologie, Neuroradiologie und Nuklearmedizin, Knappschaft Kliniken, Universitätsklinikum Bochum, Bochum, Germany.
³⁶ Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
³⁷ Center of Neuroradiology, medbo District Hospital and University Medical Center Regensburg, Regensburg, Germany.
³⁸ Department of Neuroradiology, University Hospital Giessen, Giessen, Germany.
³⁹ Neuroradiology Department, Sana Kliniken, Lübeck, Germany.
⁴⁰ Institute of Neuroradiology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany.

PMID: 40824387
DOI: 10.1007/s00062-025-01549-w

Abstract

Background: Embolization of the middle meningeal artery (EMMA) is a promising novel technique for the treatment of patients with chronic subdural hematomas (cSDH).

Methods: After a nationwide query in Germany, patients with cSDH, treated with EMMA were retrospectively analyzed. Patient and cSDH characteristics, procedural parameters, complications, and rates of treatment failure (TF; residual cSDH > 10 mm, cSDH progression or requirement of rescue surgery) were investigated. TF rates were compared between first-time treatments and treatments of recurrent cSDH, patients receiving embolization and surgery and those being embolized only, different types of embolic agents (particles vs. liquid agents) and between patients with and without antithrombotic medication.

Results: 718 EMMAs (420 unilateral, 149 bilateral) were performed in 569 patients in 30 German neurovascular centers. 57.1% were first-time treatments and 42.9% were treatments of recurrent cSDHs. The most frequently used embolic agents were particles (56.2%), followed by copolymer-based liquid embolic agents (19.6%). The rate of symptomatic procedure-related complications was 2.5%. After a mean follow-up of 6.5 months, TF was observed in 16.2% across all treatments and was more frequent after the treatment of recurrent cSDHs (19.8% vs. 13.5%, p = 0.045) and in patients taking antithrombotic drugs (17.7% vs. 11.5%; p = 0.044). TF was not significantly different regarding the type of embolic agent or additional surgery.

Conclusions: In this nationwide multi-center study, EMMA was associated with favorable clinical outcomes and a low complication rate, supporting the results of recently published randomized controlled trials. TF was more frequent in recurrent cSDH treatments and in patients taking antithrombotic drugs.

Keywords: Chronic subdural hematoma; Chronic subdural hemorrhage; Embolization; Middle meningeal artery.

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Conflict of interest statement

Conflict of interest: D.F. Vollherbst reports consultancy for Medtronic Neurovascular, and Paid Lectures for Cerenovus, TerumoNeuro and Balt. T. Boeck-Behrens reports consultancy for Terumo Neuro, BALT, MIVI and Acandis and received speaker fees from Philips. C. Lukas received consulting and speaker’s honoraria from Biogen Idec, Bayer Vital GmbH, BMS, Daiichi Sankyo, Merck Serono, Novartis and Sanofi. F. Kämmerer received consulting honoraria and travel grants from Cerenovous & travel grants from Balt and wallabyphenox. S. Meckel reports consultancy for Acandis GmbH, Balt, Medtronic and Stryker, and paid lectures for Penumbra, and is Member of the Scientific Advisory Board for Novartis Pharma GmbH. C. Kabbasch serves as consultant for Acandis GmbH (Pforzheim, Germany) and as proctor for MicroVention Inc./Sequent Medical (Aliso Viejo, CA, USA). MB reports board membership: DSMB Vascular Dynamics; consultancy: Roche, Guerbet, Codman; grants/grants pending: DFG, Hopp Foundation, Novartis, Siemens, Guerbet, Stryker, Covidien; payment for lectures (including service on speakers bureaus): Novartis, Roche, Guerbet, Teva, Bayer, Codman. MAM has received consulting honoraria, speaker honoraria, and travel support outside this work from Codman, Covidien/Medtronic, MicroVention, Phenox, and Stryker. The other authors declare that they do not have any conflicts of interest.

References

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Middle Meningeal Artery Embolization for the Treatment of Chronic Subdural Hematomas-a German Nationwide Multi-center Study On 718 Embolizations

Affiliations

Middle Meningeal Artery Embolization for the Treatment of Chronic Subdural Hematomas-a German Nationwide Multi-center Study On 718 Embolizations

Authors

Affiliations

Abstract

Conflict of interest statement

References

LinkOut - more resources

Full Text Sources

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