[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-435606-105":59,"doc-detail-435606-en":131},{"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":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","middle-meningeal-artery-embolization-mmae-for-chronic-subdural-hematoma-a-milestone-shift-in-management","Middle meningeal artery embolization (MMAE) for chronic subdural hematoma - a milestone shift in management","","Chronic subdural hematoma (cSDH) affects elderly patients and stems from recurrent bridging-vein rupture, bleeding, and membrane formation, supported by evidence of persistent inflammation and impaired neocapillary development that drives repeated microhemorrhage. Standard burr-hole craniostomy with closed-system drainage decompresses symptoms but fails to address underlying vascular pathology, contributing to high recurrence. Middle meningeal artery embolization (MMAE) targets the membrane’s vascular supply and reduces recurrence, with potential benefits as primary or adjunctive therapy while requiring minimal anesthesia in selected patients.",{"@graph":69,"@context":123},[70,84,106],{"@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/middle-meningeal-artery-embolization-mmae-for-chronic-subdural-hematoma-a-milestone-shift-in-management/435606/",{"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/middle-meningeal-artery-embolization-mmae-for-chronic-subdural-hematoma-a-milestone-shift-in-management/435606.png","ImageObject",300,407,{"name":92,"@type":93},"OmBimo","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What causes chronic subdural hematoma and why does it recur after standard treatment?","Question",{"text":113,"@type":114},"cSDH involves recurring rupture of bridging veins, bleeding, and membrane formation within the subdural space. Standard burr-hole surgery decompresses symptoms but does not treat the underlying vascular pathology, so recurrence remains high.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How does middle meningeal artery embolization (MMAE) work in cSDH?",{"text":118,"@type":114},"MMAE targets the vascular supply of the membrane associated with hematoma recurrence. By embolizing these vessels, it aims to reduce recurrence and support hematoma resolution.",{"name":120,"@type":111,"acceptedAnswer":121},"What advantages and limitations are discussed for MMAE?",{"text":122,"@type":114},"MMAE can be performed with minimal anesthesia, supports rapid recovery and discharge, and may reduce costs, with exceedingly rare risk of ischemic stroke or cranial nerve palsy. Limitations include lack of established patient selection criteria, limited comparative data on embolic agents, and ongoing investigation of long-term outcomes and required expertise in resource-limited settings.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},435606,1790789533,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":24,"preview_page_count":4},962090893581,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Letter to the Editor  \nMiddle meningeal artery embolization (MMAE) for chronic subdural hematoma: a milestone shift in management  \nFahad Amin, MBBSa , Ammad Abid, MBBSa , Raghabendra Kumar Mahato, MBBSb ,*  \nTo the Editor,  \nChronic subdural hematoma (cSDH) is among the most frequent neurosurgical diseases in the elderly population. It involves recurring rupture of the bridging veins, bleeding, and membrane formation inside the subdural space. Recent research shows that cSDH includes persistent inflammation and weak neocapillary formation, causing recurring microhemorrhage events[1] . Standard treatment for cSDH is burr-hole craniostomy combined with closed-system drainage. It results in fast decompression and symptom alleviation but does not treat the underlying vascular pathology. Thus it is linked with a great recurrence rate requiring recurrent surgical treatment[2] .  \nRecently, middle meningeal artery embolization (MMAE) has emerged as a promising alternative. This technique involves targeting the vascular supply of the membrane responsible for hematoma recurrence. Several trials have validated the efficacy of this technique. One trial demonstrated a significant reduction in recurrence, occurring in 16% of patients in the embolization group compared with 36% with standard care[3] . MMAE has also demonstrated benefit even as an adjunct to surgical evacuation. A trial reported high rates of hematoma resolution and a markedly reduced need for repeat surgical evacuation when MMAE was performed either as a primary or adjunctive treat-  \n[4]  \nment to surgery .  \nIn addition to preventing recurrence, MMAE also presents some practical advantages. It can be performed under minimal anesthesia, making it suitable for frail or anticoagulated patients. Moreover, due to its minimally invasive nature, it allows rapid recovery and discharge. It can also minimize costs associated with repeated surgeries and hospital stays  \naFaculty of Medicine, King Edward Medical University, Lahore, Pakistan and bDepartment of Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Nepal  \nSponsorships or competing interests that may be relevant to content are disclosed at the end of this article.  \n*Corresponding author. Address: Department of Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara 33700, Nepal. Tel.: +977 9745829807. E-mail: [102raghabendrakumarmahato@gmail.com](102raghabendrakumarmahato@gmail.com)[ ](102raghabendrakumarmahato@gmail.com)(R.K. Mahato).  \nCopyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.  \nAnnals of Medicine & Surgery (2026) 88:1062–1063  \nReceived 4 November 2025; Accepted 13 November 2025  \nPublished online 25 November 2025  \n[http://dx.doi.org/10.1097/MS9.0000000000004432](http://dx.doi.org/10.1097/MS9.0000000000004432)  \nassociated with the traditional techniques. Due to the embolic nature of the technique, the risk of ischemic stroke and cranial nerve palsy is exceedingly rare [5] . These results accentuate a change from the conventional mechanical techniques to modern embolic ones.  \nAlthough MMAE offers a significant improvement in the treatment of cSDH, many obstacles obstruct its broader use. It lacks established best patient selection criteria, which reduces its generalizability among the patient population. Furthermore, comparative data on the effectiveness and preference of embolicagents are limited. Long-term patient outcomes, including neurocognitive recovery, quality of life, and cost-effectiveness, are still under investigation. The expertise needed to execute this technique presents yet another challe","cbCaiis3vEzL1uDX","https://ap.wps.com/l/cbCaiis3vEzL1uDX","pdf",164998,"English","# To the Editor\n## Background on cSDH and standard management\n## Rationale and evidence for MMAE\n## Practical advantages and risks\n## Barriers to wider adoption\n## Conclusion and future needs","[{\"question\":\"What causes chronic subdural hematoma and why does it recur after standard treatment?\",\"answer\":\"cSDH involves recurring rupture of bridging veins, bleeding, and membrane formation within the subdural space. Standard burr-hole surgery decompresses symptoms but does not treat the underlying vascular pathology, so recurrence remains high.\"},{\"question\":\"How does middle meningeal artery embolization (MMAE) work in cSDH?\",\"answer\":\"MMAE targets the vascular supply of the membrane associated with hematoma recurrence. By embolizing these vessels, it aims to reduce recurrence and support hematoma resolution.\"},{\"question\":\"What advantages and limitations are discussed for MMAE?\",\"answer\":\"MMAE can be performed with minimal anesthesia, supports rapid recovery and discharge, and may reduce costs, with exceedingly rare risk of ischemic stroke or cranial nerve palsy. Limitations include lack of established patient selection criteria, limited comparative data on embolic agents, and ongoing investigation of long-term outcomes and required expertise in resource-limited settings.\"}]","Middle meningeal artery embolization (MMAE) for chronic subdural hematoma - a milestone shift in management | PDF",1790674389]