[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-434629-105":59,"doc-detail-434629-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","embolic-materials-in-middle-meningeal-artery-embolization-for-chronic-subdural-hematoma","Embolic Materials in Middle Meningeal Artery Embolization for Chronic Subdural Hematoma","","Embolic materials in middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH) are reviewed with emphasis on mechanisms, practical handling, and evidence. Recurrence has been linked to angiogenesis and leakage from fragile neovasculature supplied by distal middle meningeal artery branches. MMAE, alone or adjunct to burr-hole drainage, reduces recurrence and reoperation. The review compares EVOH-based agents (Onyx, Squid), PLGA/HEMA-based PHIL, NBCA, particulates (PVA, TGM/Embosphere), and coils, noting strengths such as controlled distal penetration and limitations including higher recanalization risk for particulates. It highlights limited comparative evidence and calls for further studies to standardize strategies.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/embolic-materials-in-middle-meningeal-artery-embolization-for-chronic-subdural-hematoma/434629/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/embolic-materials-in-middle-meningeal-artery-embolization-for-chronic-subdural-hematoma/434629.png","ImageObject",300,407,{"name":92,"@type":93},"Melati","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is embolic material choice important in MMAE for chronic subdural hematoma?","Question",{"text":112,"@type":113},"Material choice influences injection behavior, distal penetration, occlusion durability, and complication risk. The review contrasts controlled deep penetration and durable occlusion with agents like EVOH-based materials against higher recanalization risk seen with some particulates.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What advantages do EVOH-based embolic materials (Onyx, Squid) provide?",{"text":117,"@type":113},"EVOH-based agents are nonadhesive, enabling controlled slow injection and deep penetration into distal branches. They support durable occlusion and provide consistent fluoroscopic visualization through radiopacity generated by tantalum powder.",{"name":119,"@type":110,"acceptedAnswer":120},"How do particulates and coils differ from liquid embolic agents in MMAE?",{"text":121,"@type":113},"Particulates such as PVA particles and trisacryl gelatin microspheres are inexpensive and widely available but carry a higher recanalization risk. Coils alone have limited efficacy yet can protect during liquid embolic injection, and particulates are often combined with coils or liquid embolics.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},434629,1791094980,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962085570644,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Journal of Neuroendovascular Therapy 2025; 19: 2025-0126 DOI: 10.5797/jnet.ra.2025-0126  \nEmbolic Materials in Middle Meningeal Artery Embolization for Chronic Subdural Hematoma  \nKazutaka Sumita, Sakyo Hirai, Kyohei Fujita, Satoru Takahashi, Shoko Fujii, Hirotaka Sagawa, and Hikaru Wakabayashi  \nRecurrence of chronic subdural hematoma (cSDH) has been suggested to involve angiogenesis and leakage from the fragile neovasculature within the outer membrane of the hematoma, which is primarily supplied by the distal branches of the middle meningeal artery. Middle meningeal artery embolization (MMAE) has recently gained recognition as an effective treatment, either as a standalone procedure or as an adjunct to burr-hole drainage, to reduce recurrence and reoperation rates. Various embolic materials are used in MMAE, including ethylene-vinyl alcohol copolymer (EVOH)-based agents (Onyx [Medtronic, Irvine, CA, USA], Squid [Balt, Montmorency, France]), polylactide-co-glycolide (PLGA) and polyhydroxyethyl methacrylate (HEMA)-based agent (PHIL; Terumo Neuro, Aliso Viejo, CA, USA), n-butyl cyanoacrylate (NBCA), particulates such as polyvinyl alcohol (PVA) and trisacryl gelatin microspheres (TGM), and coils. EVOH-based and PLGA-HEMA-based agents provide controlled deep distal penetration and durable occlusion, providing the strongest evidence in recent randomized controlled trials. NBCA enables rapid and cost-effective embolization but requires precise technique to prevent complications such as catheter entrapment. Particulates (PVA and TGM) are inexpensive and widely available, yet carry a higher recanalization risk and are often combined with coils or liquid embolics. Coils alone have limited efficacy, although they serve a protective role during liquid embolic injection. In Japan, NBCA is the predominant material, often combined with coils or particles, due to insurance coverage and guideline recommendations. Comparative evidence among embolic agents remains limited, highlighting the need for further studies to define optimal materialselection and standardize MMAE strategies.  \nKeywords▶ chronic subdural hematoma, middle meningeal artery embolization, embolic materials  \n Introduction  \nThe recurrence and progression of chronic subdural hematoma (cSDH) have been suggested to involve angiogenesis and leakage from fragile neovasculature within the outer membrane of the hematoma, which receives its primary supply from distal branches of the middle  \nDepartment of Endovascular Surgery, Institute of Science Tokyo, Tokyo, Japan  \nReceived: October 6, 2025; Accepted: December 9, 2025  \nCorresponding author: Kazutaka Sumita. Department of Endovascular Surgery, Institute of Science Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan  \nEmail: [sumita.nsrg@tmd.ac.jp](sumita.nsrg@tmd.ac.jp)  \nThis work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.  \n©2025 The Japanese Society for Neuroendovascular Therapy  \nmeningeal artery (MMA) . Burr-hole drainage with irrigation and hematoma evacuation is the common procedure for cSDH treatment. In recent years, middle meningeal artery embolization (MMAE) has emerged as a therapeutic strategy designed to occlude this vascular supply. This approach has attracted increasing attention for its effectiveness in both initial treatment and reducing recurrence and the need for additional surgical interventions. Between 2024 and 2025, several randomized controlled trials (RCTs), including EMBOLISE, STEM, and MAGIC-MT, have reported favorable results supporting the efficacy of MMAE, which has contributed to its growing adoption, particularly outside Japan, as part of the standard treatment paradigm for cSDH. 1–5) A consensus statement by cSDH experts on disease management also identified MMAE as an adjunct to conventional surgical and nonsurgical management.6) In these studies, systematic reviews, and case series, various embolic agents have been employed.7,8) Liquid embolic","cbCairzjVW8jg84a","https://ap.wps.com/l/cbCairzjVW8jg84a","pdf",542500,"English","# Introduction\n## Characteristics of Each Embolic Material and Practical Points\n## EVOH-based liquid embolic materials (Onyx, Squid)","[{\"question\":\"Why is embolic material choice important in MMAE for chronic subdural hematoma?\",\"answer\":\"Material choice influences injection behavior, distal penetration, occlusion durability, and complication risk. The review contrasts controlled deep penetration and durable occlusion with agents like EVOH-based materials against higher recanalization risk seen with some particulates.\"},{\"question\":\"What advantages do EVOH-based embolic materials (Onyx, Squid) provide?\",\"answer\":\"EVOH-based agents are nonadhesive, enabling controlled slow injection and deep penetration into distal branches. They support durable occlusion and provide consistent fluoroscopic visualization through radiopacity generated by tantalum powder.\"},{\"question\":\"How do particulates and coils differ from liquid embolic agents in MMAE?\",\"answer\":\"Particulates such as PVA particles and trisacryl gelatin microspheres are inexpensive and widely available but carry a higher recanalization risk. Coils alone have limited efficacy yet can protect during liquid embolic injection, and particulates are often combined with coils or liquid embolics.\"}]","Embolic Materials in Middle Meningeal Artery Embolization for Chronic Subdural Hematoma | PDF",1790670060,25]