Open Access

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

• 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 usedBackground: 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.…