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Middle Meningeal Artery Embolization for Nonacute Subdural Hematoma.

N Engl J Med

November 2024

From the Neurovascular Center (J. Liu, Q.Z., P.Z., L.C., Yongxin Zhang, F.S., Y. Wu, G.D., N.L., X.X., Zifu Li, Y. Zhou, L.Z., D.D., Yongwei Zhang, R.Z., Y.X., Q.L., P.Y.), Trauma Center (J. Liu, Q.Z.), and Department of Radiology (B.T.), Naval Medical University Changhai Hospital, the Key Laboratory of Molecular Neurobiology of the Ministry of Education, Naval Medical University (J. Liu, P.Y.), the Oriental PanVascular Devices Innovations College, University of Shanghai for Science and Technology (J. Liu, H.Z., P.Y.), the Departments of Neurosurgery (W.N., H.Y., J.Y., Z.D., J.H., Q.Y., G.W., C.G., X.W., H.J., J.S., Y.G., Y.M.) and Neurology (X.C., Z.W.), and the National Center for Neurological Disorders (Y.G., Y.M.), Fudan University Huashan Hospital, the Department of Neurosurgery, Fudan University Huashan Hospital North (Y. Lei, Yanjiang Li, L.X.), Neurosurgical Institute Fudan University and Shanghai Clinical Medical Center of Neurosurgery (Y.G., Y.M.), the Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (X.H.), the Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University (J. Wan), the Department of Neurosurgery, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Yi Li), and the Department of Neurosurgery, Shanghai Tenth People's Hospital (L.G.), Shanghai, the Department of Neurosurgery, First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, First Affiliated Hospital of Ningbo University, Ningbo (Z. Lin), the Department of Neurosurgery, Yijishan Hospital, the First Affiliated Hospital of Wannan Medical College, Wuhu (Zhenbao Li), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (J. Wang), the Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou (Y. Zhen), the Department of Neurosurgery, First Affiliated Hospital of Anhui Medical University, Hefei (J. Luo), the Department of Neurosurgery, First Affiliated Hospital of Fujian Medical University, Fuzhou (Y. Lin), the Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong (J.C.), the Department of Neurosurgery, Jiangsu Provincial Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing (H.L.), the Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (M.Z.), the Department of Neurosurgery, Shantou Central Hospital, Shantou (M.L.), the Department of Neurosurgery, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou (J.Z.), the Department of Neurosurgery, Capital Medical University Beijing Chaoyang Hospital, Beijing (Y. Wang), the Department of Neurosurgery, Henan Provincial People's Hospital, Zhengzhou (T.L.), the Department of Neurosurgery, Second Affiliated Hospital of Nanchang University, Nanchang (G.M.), the Department of Neurosurgery, Zhongnan Hospital Wuhan University, Wuhan (W.Z.), the Department of Neurosurgery, the First Hospital of Hebei Medical University, Shijiazhuang (C.L.), and the Department of Neurosurgery, Zhongshan Hospital Xiamen University, Xiamen (E.C.) - all in China; the Departments of Diagnostic Imaging (J.M.O.), Radiology (M.G.), and Clinical Neurosciences (M.G.), University of Calgary, Calgary, AB, Canada; and the Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam (C.B.L.M.M.).

Jianmin Liu Wei Ni Qiao Zuo Heng Yang Ya Peng

Background: The effect of embolization of the middle meningeal artery in patients with subacute or chronic subdural hematoma is uncertain.

Methods: We performed a multicenter, open-label, randomized trial in China, involving patients with symptomatic nonacute subdural hematoma with mass effect. Patients were assigned to undergo burr-hole drainage or receive nonsurgical treatment at the surgeon's discretion, and patients in each group were then randomly assigned, in a 1:1 ratio, to undergo middle meningeal artery embolization with liquid embolic material or to receive usual care.

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