Evidence map›Paper›PMID 42477235›Full record

ArticleNeurosurgical review2026

Middle meningeal artery arteriovenous shunting after surgical evacuation of chronic subdural hematoma: a retrospective angiographic cohort study.

Malvina Garner, Frederik Fries, Alena Haußmann, Wolfgang Reith, Umut Yilmaz

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Article in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

5 authors.

Malvina GarnerDepartment of Neuroradiology, Saarland University Hospital, Kirrberger Str, Homburg, Saar, 66424, Germany.
Frederik FriesDepartment of Neuroradiology, Saarland University Hospital, Kirrberger Str, Homburg, Saar, 66424, Germany.
Alena HaußmannDepartment of Neuroradiology, Saarland University Hospital, Kirrberger Str, Homburg, Saar, 66424, Germany.
Wolfgang ReithDepartment of Neuroradiology, Saarland University Hospital, Kirrberger Str, Homburg, Saar, 66424, Germany.
Umut YilmazDepartment of Neuroradiology, Saarland University Hospital, Kirrberger Str, Homburg, Saar, 66424, Germany. umut.yilmaz@uks.eu.ORCID https://orcid.org/0000-0003-4940-3575

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Arteriovenous shunting involving the middle meningeal artery (MMA) has been reported after cranial trauma, neurosurgical procedures, and endovascular interventions. However, its angiographic frequency and characteristics after chronic subdural hematoma (cSDH) surgery remain poorly defined. This study aimed to assess the frequency and angiographic features of MMA arteriovenous shunting in patients undergoing MMA embolization after surgical evacuation of cSDH. We retrospectively analyzed consecutive patients who underwent selective and superselective MMA angiography during MMA embolization after surgical evacuation of cSDH between January 2020 and March 2023. Angiograms were reviewed for angiographic evidence of arteriovenous shunting, shunt morphology, flow characteristics, venous drainage, relationship to embolization, and angiographic closure after embolization. Surgical technique was classified as burr-hole craniotomy or formal craniotomy. Thirty patients met the inclusion criteria. Angiographic evidence of MMA arteriovenous shunting was identified in 11 patients (36.7%). Shunting was significantly more frequent after craniotomy than after burr-hole craniotomy (90.9% vs. 5.3%, Fisher's exact test, p < 0.001). Most shunts were detectable before microcatheter advancement, while superselective angiography improved visualization of shunt morphology and venous drainage. All shunts demonstrated low-flow angiographic characteristics without cortical venous reflux. Post-embolization control angiography demonstrated disappearance of the angiographic shunt in all affected patients. Low-flow arteriovenous shunting involving the MMA is a frequent angiographic finding in patients undergoing MMA embolization after cSDH surgery, particularly following craniotomy. These findings provide systematic angiographic characterization of a previously underrecognized postoperative vascular phenomenon. The clinical relevance of such shunting remains uncertain and warrants prospective investigation.

Indexed as

Arteriovenous FistulaHematoma, Subdural, ChronicMeningeal ArteriesAdultAgedAged, 80 and overCerebral AngiographyCraniotomyEmbolization, TherapeuticFemaleHumansMaleMiddle AgedRetrospective StudiesAngiographyArteriovenous fistulaChronic subdural hematomaCraniotomyEmbolizationMiddle meningeal artery

Identifiers

PMID42477235
PMCPMC13385009

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.