Preoperative middle meningeal artery embolization is associated with reduced reoperation rates in chronic subdural hematoma
Bibliographic record
Abstract
Background Middle meningeal artery embolization (MMAE) has recently emerged as a promising adjunctive therapy to surgical evacuation for patients with chronic subdural hematoma (cSDH). However, the optimal timing of MMAE relative to surgery remains poorly defined. Therefore, this large retrospective cohort study aimed to assess the impact of MMAE timing (preoperative vs. postoperative) on 6-month outcomes in patients with cSDH, focusing on rates of repeat surgery and mortality. We hypothesized that preoperative MMAE would be associated with lower rates of reoperation compared to postoperative MMAE. Methods Adult patients with nontraumatic cSDH who underwent surgery with adjunctive MMAE were identified using ICD-10 codes from the TriNetX database. A 1:1 propensity score matching approach was used to balance baseline characteristics between groups. The primary outcomes were repeat surgery and all-cause mortality within 6 months. Results A total of 338 matched patients ( n = 338; 169 in each group) were included in the final analysis. Preoperative MMAE was associated with significantly lower odds of repeat surgery compared to postoperative MMAE (7.1% vs. 17.8%; OR 0.35, p = 0.003). No significant difference was observed in 6-month all-cause mortality between the groups. Conclusion Preoperative MMAE is associated with reduced odds of repeat surgery compared to postoperative MMAE at 6 months. These findings support consideration of MMAE timing in surgical planning. Further prospective studies are warranted to validate these results.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".