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

Dominik F Vollherbst; Ansgar Berlis; Mahmoud Zaki; Christoph Maurer; Christina Onyinzo; Fee C Keil; Leonard Mann; Christophe T Arendt; Marius Hartmann; Steffen Reißberg; Corinna Rutschke; Kai Kallenberg; Stefan Grau; Alexandru Durutya; Adrian Liebert; Heinz L Voit-Höhne; Markus Holtmannspötter; Christian Herweh; René Chapot; Mohamed Elsharkawy; Dan Meila; Björn Greling; Frederik Boxberg; Dominik Grieb; Cornelius Deuschl; Yahya Ahmadipour; Tobias Boeckh-Behrens; Jannis Bodden; Carsten Lukas; Felix Kämmerer; Daniel Behme; Elie Diamandis; Eberhard Siebert; Aymen Meddeb; Kornelia Kreiser; Sabine Heinz; Stephan Meckel; Semin Berzeg-Kolck; Jens Fiehler; Matthias Bechstein; Marius G Kaschner; Keihan Darvishi; Laura S Leukert; Marc A Brockmann; Thomas E Mayer; Jan-Hendrik Buhk; Charlotte S Weyland; Lukas Görtz; Christoph Kabbasch; Werner Weber; Christina Wendl; Tobias Struffert; Christian Dyzmann; Johannes C Gerber; Martin Bendszus; Markus A Möhlenbruch

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
, Ansgar Berlis
, Mahmoud Zaki
, Christoph Maurer
, Christina Onyinzo
, Fee C Keil
, Leonard Mann
, Christophe T Arendt
, Marius Hartmann
, Steffen Reißberg
, Corinna Rutschke
, Kai Kallenberg
, Stefan Grau
, Alexandru Durutya
, Adrian Liebert (Co-author)
, Heinz L Voit-Höhne (Co-author)
, Markus Holtmannspötter (Co-author)
, Christian Herweh
, René Chapot
, Mohamed Elsharkawy

Dan Meila, Björn Greling, Frederik Boxberg, Dominik Grieb, Cornelius Deuschl, Yahya Ahmadipour, Tobias Boeckh-Behrens, Jannis Bodden, Carsten Lukas, Felix Kämmerer, Daniel Behme, Elie Diamandis, Eberhard Siebert, Aymen Meddeb, Kornelia Kreiser, Sabine Heinz, Stephan Meckel, Semin Berzeg-Kolck, Jens Fiehler, Matthias Bechstein, Marius G Kaschner, Keihan Darvishi, Laura S Leukert, Marc A Brockmann, Thomas E Mayer, Jan-Hendrik Buhk, Charlotte S Weyland, Lukas Görtz, Christoph Kabbasch, Werner Weber, Christina Wendl, Tobias Struffert, Christian Dyzmann, Johannes C Gerber, Martin Bendszus, Markus A Möhlenbruch

Research output: Contribution to journal › Original Article › peer-review

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.

Original language	English
Number of pages	10
Journal	CLINICAL NEURORADIOLOGY
Early online date	Aug 2025
DOIs	https://doi.org/10.1007/s00062-025-01549-w
Publication status	Published - 18 Aug 2025

Access to Document

10.1007/s00062-025-01549-w

Cite this

Vollherbst, D. F., Berlis, A., Zaki, M., Maurer, C., Onyinzo, C., Keil, F. C., Mann, L., Arendt, C. T., Hartmann, M., Reißberg, S., Rutschke, C., Kallenberg, K., Grau, S., Durutya, A., Liebert, A., Voit-Höhne, H. L., Holtmannspötter, M., Herweh, C., Chapot, R., ... Möhlenbruch, M. A. (2025). Middle Meningeal Artery Embolization for the Treatment of Chronic Subdural Hematomas-a German Nationwide Multi-center Study On 718 Embolizations. CLINICAL NEURORADIOLOGY. https://doi.org/10.1007/s00062-025-01549-w

@article{46975e7fef5c448fb63a48f6a835f105,

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

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.",

author = "Vollherbst, \{Dominik F\} and Ansgar Berlis and Mahmoud Zaki and Christoph Maurer and Christina Onyinzo and Keil, \{Fee C\} and Leonard Mann and Arendt, \{Christophe T\} and Marius Hartmann and Steffen Rei{\ss}berg and Corinna Rutschke and Kai Kallenberg and Stefan Grau and Alexandru Durutya and Adrian Liebert and Voit-H{\"o}hne, \{Heinz L\} and Markus Holtmannsp{\"o}tter and Christian Herweh and Ren{\'e} Chapot and Mohamed Elsharkawy and Dan Meila and Bj{\"o}rn Greling and Frederik Boxberg and Dominik Grieb and Cornelius Deuschl and Yahya Ahmadipour and Tobias Boeckh-Behrens and Jannis Bodden and Carsten Lukas and Felix K{\"a}mmerer and Daniel Behme and Elie Diamandis and Eberhard Siebert and Aymen Meddeb and Kornelia Kreiser and Sabine Heinz and Stephan Meckel and Semin Berzeg-Kolck and Jens Fiehler and Matthias Bechstein and Kaschner, \{Marius G\} and Keihan Darvishi and Leukert, \{Laura S\} and Brockmann, \{Marc A\} and Mayer, \{Thomas E\} and Jan-Hendrik Buhk and Weyland, \{Charlotte S\} and Lukas G{\"o}rtz and Christoph Kabbasch and Werner Weber and Christina Wendl and Tobias Struffert and Christian Dyzmann and Gerber, \{Johannes C\} and Martin Bendszus and M{\"o}hlenbruch, \{Markus A\}",

note = "Holtmansp{\"o}tter, Voith: Department of Neuroradiology, Paracelsus Medical University, Nuremberg, Germany; Liebert: Department of Neurosurgery, Paracelsus Medical University, Nuremberg, Germany",

year = "2025",

month = aug,

day = "18",

doi = "10.1007/s00062-025-01549-w",

language = "English",

journal = "CLINICAL NEURORADIOLOGY",

issn = "1869-1439",

publisher = "Springer Nature",

}

Vollherbst, DF, Berlis, A, Zaki, M, Maurer, C, Onyinzo, C, Keil, FC, Mann, L, Arendt, CT, Hartmann, M, Reißberg, S, Rutschke, C, Kallenberg, K, Grau, S, Durutya, A, Liebert, A , Voit-Höhne, HL , Holtmannspötter, M, Herweh, C, Chapot, R, Elsharkawy, M, Meila, D, Greling, B, Boxberg, F, Grieb, D, Deuschl, C, Ahmadipour, Y, Boeckh-Behrens, T, Bodden, J, Lukas, C, Kämmerer, F, Behme, D, Diamandis, E, Siebert, E, Meddeb, A, Kreiser, K, Heinz, S, Meckel, S, Berzeg-Kolck, S, Fiehler, J, Bechstein, M, Kaschner, MG, Darvishi, K, Leukert, LS, Brockmann, MA, Mayer, TE, Buhk, J-H, Weyland, CS, Görtz, L, Kabbasch, C, Weber, W, Wendl, C, Struffert, T, Dyzmann, C, Gerber, JC, Bendszus, M & Möhlenbruch, MA 2025, 'Middle Meningeal Artery Embolization for the Treatment of Chronic Subdural Hematomas-a German Nationwide Multi-center Study On 718 Embolizations', CLINICAL NEURORADIOLOGY. https://doi.org/10.1007/s00062-025-01549-w

TY - JOUR

T1 - Middle Meningeal Artery Embolization for the Treatment of Chronic Subdural Hematomas-a German Nationwide Multi-center Study On 718 Embolizations

AU - Vollherbst, Dominik F

AU - Berlis, Ansgar

AU - Zaki, Mahmoud

AU - Maurer, Christoph

AU - Onyinzo, Christina

AU - Keil, Fee C

AU - Mann, Leonard

AU - Arendt, Christophe T

AU - Hartmann, Marius

AU - Reißberg, Steffen

AU - Rutschke, Corinna

AU - Kallenberg, Kai

AU - Grau, Stefan

AU - Durutya, Alexandru

AU - Liebert, Adrian

AU - Voit-Höhne, Heinz L

AU - Holtmannspötter, Markus

AU - Herweh, Christian

AU - Chapot, René

AU - Elsharkawy, Mohamed

AU - Meila, Dan

AU - Greling, Björn

AU - Boxberg, Frederik

AU - Grieb, Dominik

AU - Deuschl, Cornelius

AU - Ahmadipour, Yahya

AU - Boeckh-Behrens, Tobias

AU - Bodden, Jannis

AU - Lukas, Carsten

AU - Kämmerer, Felix

AU - Behme, Daniel

AU - Diamandis, Elie

AU - Siebert, Eberhard

AU - Meddeb, Aymen

AU - Kreiser, Kornelia

AU - Heinz, Sabine

AU - Meckel, Stephan

AU - Berzeg-Kolck, Semin

AU - Fiehler, Jens

AU - Bechstein, Matthias

AU - Kaschner, Marius G

AU - Darvishi, Keihan

AU - Leukert, Laura S

AU - Brockmann, Marc A

AU - Mayer, Thomas E

AU - Buhk, Jan-Hendrik

AU - Weyland, Charlotte S

AU - Görtz, Lukas

AU - Kabbasch, Christoph

AU - Weber, Werner

AU - Wendl, Christina

AU - Struffert, Tobias

AU - Dyzmann, Christian

AU - Gerber, Johannes C

AU - Bendszus, Martin

AU - Möhlenbruch, Markus A

N1 - Holtmanspötter, Voith: Department of Neuroradiology, Paracelsus Medical University, Nuremberg, Germany; Liebert: Department of Neurosurgery, Paracelsus Medical University, Nuremberg, Germany

PY - 2025/8/18

Y1 - 2025/8/18

N2 - 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.

AB - 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.

U2 - 10.1007/s00062-025-01549-w

DO - 10.1007/s00062-025-01549-w

M3 - Original Article

C2 - 40824387

SN - 1869-1439

JO - CLINICAL NEURORADIOLOGY

JF - CLINICAL NEURORADIOLOGY

ER -

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

Abstract

Access to Document

Fingerprint

Cite this