Middle meningeal artery Embolization Reduces Recurrence of Chronic Subdural Hematoma, need for repeat surgery: JAMA
A new study published in the Journal of American Medical Association showed that when combined with normal treatment, middle meningeal artery embolization (MMAE) with n-butyl cyanoacrylate (n-BCA) dramatically decreased the requirement for repeat surgery and the likelihood of chronic subdural hematoma (cSDH) recurrence or re-accumulation.
A minimally invasive supplemental therapy for cSDH is middle meningeal artery embolization (MMAE). The TRUFILL n-BCA liquid embolic system may be suitable for MMAE in patients with cSDH and is recommended for embolization of cerebral arteriovenous malformations for presurgical devascularization. Thus, this research compared the safety and efficacy of the study device for MMAE plus standard of treatment with standard of care alone in patients with cSDH.
Embolization of the Middle Meningeal Artery to Treat Subdural Hematomas The TRUFILL n-BCA (MEMBRANE) experiment was a prospective, multicenter, open-label, randomized clinical investigation that took place at 30 hospitals (28 in the US and 2 in China) between May 27, 2021, and February 6, 2024.
Individuals with symptomatic cSDH who were between the ages of 18 and 90 and had a modified Rankin Scale score of three or below were recruited. Each patient's need for surgical or nonsurgical care was assessed by site doctors. After that, participants in the surgical and nonsurgical groups were randomized 1:1 to receive either standard treatment alone or MMAE in addition to standard care.
Integrating middle meningeal artery embolization (MMAE) with standard of care substantially improved clinical outcomes when compared to standard of care alone in a study with 376 individuals. Primary effectiveness endpoint events were significantly reduced by the supplementary MMAE therapy (11.6% vs. 22.1%; OR, 0.53; $P =.04$).
Despite the MMAE cohort's somewhat higher six-month adverse event incidence (71.8% vs. 65.3%), the combined method demonstrated a clear statistical advantage with an acceptable safety profile and was noninferior to conventional treatment in obtaining satisfactory functional results at 3 months. Overall, with about one recurrence or surgical failure avoided for every ten patients treated, the 6-month results showed a favorable therapeutic impact of MMAE + SOC utilizing the study device.
Source:
Kellner, C. P., Rai, A. T., Shoirah, H., Srinivasan, V. M., Gupta, R., Starke, R. M., Al-Mufti, F., Matouk, C. C., Yim, B., Fusco, M. R., Wan, J., Liptrap, E., Bhuva, P., Grandhi, R., Cerejo, R., Liu, J. J., Cherian, J., Zhang, Q., Kaminsky, I., … Ling, H. (2026). Middle meningeal artery embolization with n-butyl cyanoacrylate in patients with chronic subdural hematoma: A randomized clinical trial. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2026.1542
