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Updated: Mar 3, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Middle Meningeal Artery Embolization Is Associated With Lower Risk of Incident Dementia Among Patients With Subdural
Huanwen Chen1, Dhairya A Lakhani2, Matthew K McIntyre3
1Neurosurgery, University of Maryland Medical Center, Baltimore (H.C., D.G.).
Background:
Nonacute subdural hematoma (NASDH) is associated with cognitive dysfunction and decline. Middle meningeal artery embolization (MMAE) has shown efficacy in reducing NASDH recurrence and promoting hematoma resorption, but its potential impact on long-term cognitive outcomes is unexplored. This study aims to determine whether standalone MMAE is associated with reduced dementia risk compared with conservative management (CM) in dementia-free patients with nonsurgical NASDH.
Methods:
This was a multicenter retrospective cohort study using the TriNetX US collaborative research network database. Adult patients with newly diagnosed NASDH who did not undergo surgical drainage were included. Patients with known dementia at the time of NASDH diagnosis were excluded. Patients who underwent standalone MMAE were compared with those who underwent CM only. The primary outcome was new-onset dementia during a 5-year study follow-up period. Secondary outcomes included all-cause mortality. One-to-one propensity score matching was performed to account for confounding and indication bias. Outcomes were compared using time-to-event analyses with Kaplan-Meier curves and Cox proportional hazards models.
Results:
Of 175 868 patients with nonsurgical NASDH, 1991 underwent MMAE. After propensity score matching, 1972 patients remained in each group with similar baseline characteristics (all absolute standardized differences <0.10). Mean follow-up was 704 days for MMAE patients and 818 days for CM patients. Compared with CM, MMAE was associated with significantly lower 5-year probability of incident dementia (6.0% versus 11.4%; P<0.001; hazard ratio 0.55 [95% CI, 0.40-0.77]), representing a 45% reduction in risk. MMAE was also associated with significantly lower all-cause mortality (25.1% versus 32.1%; P=0.001).
Conclusions:
Among nonsurgical, dementia-free patients with NASDH, standalone MMAE was associated with significantly reduced incident dementia risk compared with CM. These findings suggest MMAE may provide neurocognitive benefits beyond preventing hematoma progression, potentially through promoting hematoma resorption and preserving cortical integrity. Prospective studies are needed to confirm these hypothesis-generating observations and establish causality.
