Timing of Middle Meningeal Artery Embolization and Surgery: Analysis of the EMBOLISE Trial
Year: 2026
Type: article
Abstract: BACKGROUND: The EMBOLISE trial (The Embolization of the Middle Meningeal Artery With Onyx Liquid Embolic System in the Treatment of Subacute and Chronic Subdural Hematoma) demonstrated that middle meningeal artery embolization as an adjunct to surgical drainage reduces recurrence of symptomatic subacute and chronic subdural hematomas. We performed a subgroup analysis of the EMBOLISE surgical cohort to determine how the timing of embolization relative to surgery impacted various outcomes. METHODS: We performed a post hoc subgroup analysis to examine the association of the timing of embolization relative to surgery with the primary end point (hematoma reoperation within 90 days), secondary end points (clinical and radiographic outcomes), and safety end points (serious adverse events, neurological death, all-cause death, and stroke). RESULTS: Middle meningeal artery embolization before surgery (embolization-first group) and middle meningeal artery embolization after surgery (surgery-first group) were performed in 107 and 78 patients, respectively. Demographics and baseline clinical characteristics of the 2 groups were similar. The core laboratory confirmed the procedure to be successful in all patients with similar rates of distal penetration of Onyx into middle meningeal artery branches at the end of the embolization procedure in both groups (49.5% and 48.7%, respectively, P >0.99). Six of 103 patients in the embolization-first group (5.8%) and none in the surgery-first group needed reoperation within 90 days (analysis with observed data, P =0.08). Hematoma volumes at 90 and 180 days were similar except for lower hematoma thickness in the surgery-first group (2.3±3.0 mm versus 4.4±5.6 mm, P =0.03) at 180 days. Clinical and safety outcomes at 30, 90, and 180 days were similar. CONCLUSIONS: Performing surgical drainage before embolization in patients with subacute and chronic subdural hematomas may help minimize treatment failures and enhance hematoma resolution. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04402632.
Authors: Maxim Mokin, Jared Knopman, Jason M. Davies, Ameer E. Hassan, Robert E. Harbaugh, Alexander Khalessi, Jens Fiehler, Elad I. Levy, Bradley A. Gross, Ramesh Grandhi, Jason Tarpley, Walavan Sivakumar, Mark Bain, R. Webster Crowley, Thomas W. Link, Justin F. Fraser, Michael R. Levitt, Peng Roc Chen, Ricardo A. Hanel, Joe D. Bernard, Mouhammad Jumaa, Patrick Youssef, Marshall C. Cress, Mohammad Imran Chaudry, Hakeem J. Shakir, Walter S. Lesley, Joshua Billingsley, Jesse Jones, Matthew J. Koch, Alexandra R. Paul, William J. Mack, Joshua W. Osbun, Kathleen Dlouhy, Jonathan A. Grossberg, Christopher P. Kellner, Daniel H. Sahlein, Justin Santarelli, Clemens M. Schirmer, Paul Mazaris, Jesse J. Liu, Aniel Q. Majjhoo, Thomas Wolfe, Neil V. Patel, Christopher Roark, Adnan H. Siddiqui, on behalf of the EMBOLISE Investigators
Institutions: University of South Florida, Tampa General Hospital, NewYork–Presbyterian Hospital, Weill Cornell Medical Center, University at Buffalo, State University of New York, Valley Baptist Medical Center, Pennsylvania State University, University of California San Diego, University Medical Center Hamburg-Eppendorf, University of Pittsburgh Medical Center, University of Utah, Little Company of Mary Hospital, Cleveland Clinic, Rush University, Northwell Health, North Shore University Hospital, University of Kentucky, University of Washington, Memorial Hermann–Texas Medical Center, Baptist Medical Center Jacksonville, Carolinas Medical Center, Carolina Neurosurgery and Spine Associates, University of Toledo Medical Center, ProMedica Toledo Hospital, ProMedica, University of Toledo, The Ohio State University Wexner Medical Center, The Ohio State University, Orlando Health, Orlando Regional Medical Center, Prisma Health, University of Oklahoma Health Sciences Center, Baylor Scott & White Medical Center - Temple, Baylor Scott & White Health, Advocate Lutheran General Hospital, University of Alabama, University of Alabama at Birmingham, UAB Medicine, University of Florida Health, University of Florida, Albany Medical Center Hospital, University of Southern California, Washington University in St. Louis, University of Iowa Hospitals and Clinics, Emory University, Icahn School of Medicine at Mount Sinai, Goodman Campbell Brain and Spine, Westchester Medical Center, New York Medical College, Geisinger College of Health Sciences, Michigan State University, Oregon Health & Science University, McLaren Regional Medical Center, McLaren Health Care, McLaren Macomb, Lahey Hospital and Medical Center, Lahey Medical Center, University of Colorado Denver
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,300
OpenAlex ID: W7202374385