Citations 3
Temporal relationship between hematoma resolution and functional recovery after middle meningeal artery embolization for chronic subdural hematoma
DeMessie, Bluyé , Essibayi, Muhammed Amir, Karandish, Alireza, Park, Jaewoo , Haranhalli, Neil, Baker, Amanda, Zampolin, R, Brook, A, Lee, S, Adeeb, Nimer, Li, Yan-Lin, Ortega, Diego Alejandro, Cancelliere, N, Diestro, Jose Danilo, Carnevale, Joseph A., Schreiber, Craig , Abecassis, Zachary, Raub, Spencer, Sioutas, Georgios S. , Kvint, Svetlana , Falzon, Andrew, Cantrell, Vance, Holliday, Brian, Maleknia, Pedram D., Cruz-Criollo, Leonardo, Schimmel, Samantha, Musmar, Basel, Alexander, Matthew D. , Zermeno, Jorge Rios, Koul, Prateeka , Aljuboori, Ahmed , Vollherbst, D, Cooper, J , Ogilvy, Christopher S., Al-Mufti, Fawaz, Möhlenbruch, Markus A., Scarcia, Luca, Schirmer, Clemens M., Huynh, Thien, Settecase, Fabio , Tjoumakaris, Stavropoula, Jabbour, Pascal, Vakharia, Kunal, Zanaty, Mario, Ortega-Gutierrez, Santiago, Jones, J, Nasser, Hussein H., Sundararajan, Sri Hari , Mosimann, Pascal J., Nossek, Erez , Raz, Eytan, Kasab, S Al, Spiotta, Alejandro M., Michelozzi, Caterina , Saraceno, Davide , Srinivasan, Visish M., Burkhardt, Jan-Karl, Santini, Pietro Mario, Levitt, Michael R., Lanzino, Giuseppe, Brinjikji, Waleed, Knopman, Jared, Kass-Hout, T, Spears, Julian, Marotta, Thomas, Pereira, Vitor Mendes, Fuschi, Maurizio , Dmytriw, Adam A., Altschul, David J., _, _, Kostynskyy, Alex , Goren, Oded , Oliver, Jeffrey Daniel, Milnerowicz, Małgorzata , Papaxanthos, Jean , Eker, Omer, Barreau, Xavier, Courret, Thomas , Berge, Jerome, Engelhardt, Julien , Diestro, Jose Danilo Bengzon , Li, Yan-Lin , Rios Zermeno, Jorge , Diestro, Jose Danilo B , Li, Yan-Lin , Essibayi, Muhammed Amir , Salim, Hamza , Karandish, Alireza , Khatri, Deepak , Haranhalli, Neil , Zampolin, Richard L. , Adeeb, Nimer , Simonato, Davide , Ortega-Moreno, Diego Alejandro , Cancelliere, Nicole M , Carnevale, Joseph Anthony , Orscelik, Atakan , Abecassis, Zachary A. , Raub, Spencer , Salsano, Giancarlo , Kasem, Rahim Abo , Falzon, Andrew , Abaricia, Jefferson O. , Maleknia, Pedram Daniel , Cruz‐Criollo, Leonardo , Schimmel, Samantha J. , Musmar, Basel , Gajski, Domagoj, Alwakaa, Omar , Ogilvy, Christopher S. , Al‐Mufti, Fawaz , Kalousek, Vladimir , Möhlenbruch, Markus , Scarcia, Luca , Schirmer, Clemens M. , Huynh, Thien , Tawk, Rabih G. , Tjoumakaris, Stavropoula , Jabbour, Pascal , Zanaty, Mario , Ortega-Gutierrez, Santiago , Jones, Jesse , Colasurdo, Marco , Nasser, Hussein, Mosimann, Pascal J , Raz, Eytan , Spiotta, Alejandro M , Castellan, Lucio , Sette, Bruno Del , Panni, Pietro , Srinivasan, Visish M. , Burkhardt, Jan‐Karl , Marnat, Gaultier , Levitt, Michael R. , Lanzino, Giuseppe , Brinjikji, Waleed , Knopman, Jared , Kass‐Hout, Tareq , Spears, Julian , Dmytriw, Adam A. , Altschul, David , Galecio‐Castillo, Milagros , Cespedes, Jorge , Oliver, Jeffrey , Eker, Omer , Barreau, Xavier , Berge, Jérôme , Jecko, Vincent
Journal of Neurosurgery | May 20, 2026 | Volume: No volume available | Issue: No issue available | Pages: 1-12
OBJECTIVE The objective was to evaluate the trajectories of hematoma resolution and functional improvement after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH), model the temporal pattern of cSDH resolution, and identify factors associated with favorable outcomes. METHODS This real-world multicenter retrospective study included cSDH patients treated with MMAE at 24 centers between 2019 and 2024. Hematoma thickness was measured at baseline and at follow-up intervals (1–4 weeks, 1–3 months, 3–6 months, 6–12 months, and > 12 months after embolization). Resolution patterns were modeled using exponential decay functions. Modified Rankin Scale (mRS) scores assessed functional outcomes. Good functional outcome was defined as mRS score ≤ 2. Resolution patterns were modeled using exponential decay functions to estimate time to 50% and 80% reduction. Patients were categorized as complete resolution (≥ 99%) or by quartile of the remaining distribution (substantial [73%–98%], moderate [53%–73%], partial [27%–53%], minimal [< 27%]). The primary outcome was good functional status (mRS score ≤ 2). RESULTS The authors analyzed a total of 1781 patients with 2295 cSDHs who underwent MMAE. The mean ± SD age was 72.8 ± 12.4 years and 68.1% of patients were male. The initial mean hematoma thickness was 15.31 ± 6.53 mm, decreasing to 5.24 ± 5.91 mm at final follow-up (mean reduction 64.3% ± 42.1%). Resolution followed an exponential decay pattern, with an estimated time to 50% reduction of 1.8 months and to 80% reduction of 8.9 months. Complete resolution occurred in 1031 of 2224 patients (46.4%) with complete follow-up. The median (IQR) mRS score improved from 1 (0–3) at baseline to 0 (0–2) at > 12 months. Good functional outcomes were more common in patients with complete versus minimal resolution (68.9% vs 35.0%, p < 0.001). Achieving ≥ 73% resolution within 90 days was associated with better outcomes (good outcome in 76.9% of those with ≥ 73% resolution vs 67.3% in those without, p < 0.001). Neurological deterioration was the strongest predictor of lack of good outcome (23.7% in patients with neurological deterioration vs 82.4% without, p < 0.001). CONCLUSIONS After MMAE for cSDH, reduction in hematoma thickness follows a predictable exponential decay pattern. Greater extent (≥ 80%) and faster timing (within 90 days) of resolution are valuable prognostic indicators. Functional outcomes improve progressively through 6–12 months after the procedure. The relationship between resolution extent and functional outcomes provides quantitative benchmarks for evaluating treatment response.
Predictive modeling of long-term improvement in occlusion outcomes following Woven EndoBridge treatment of cerebral aneurysms: A machine learning approach
Karandish, Alireza , Essibayi, Muhammed Amir , Jabal, Mohamed Sobhi , Salim, Hamza , Musmar, Basel , Adeeb, Nimer , Dibas, Mahmoud , Li, Yan-Lin , Grist, James T. , Lay, Sovann V. , Guenego, Adrien , Renieri, Leonardo, Naamani, Kareem El, Möhlenbruch, Markus, Kral, Michael , Salem, Mohamed M , Foreman, Paul M. , Shaikh, Hamza , Župančić, Vedran , Ayberk, Gıyas , Rabinov, James D. , Maingard, Julian , Michelozzi, Caterina , Starke, Robert M., Ogilvie, Mark , Nguyên, Anh , Jones, Jesse , Brinjikji, Waleed , Nawka, Marie Teresa , Psychogios, Marios, Ulfert, Christian , Pukenas, Bryan , Burkhardt, Jan‐Karl , Slawski, Diana , Lubicz, Boris , Puri, Ajit S., Pero, Guglielmo , Raz, Eytan , Asadi, Hamed , Siddiqui, Adnan H. , Haranhalli, Neil , Ducruet, Andrew F. , Albuquerque, Felipe C , Regenhardt, Robert W. , Stapleton, Christopher J. , Kan, Peter , Kalousek, Vladimir , Lylyk, Pedro , Boddu, Srikanth , Knopman, Jared , Tjoumakaris, Stavropoula , Clarençon, Frédéric , Patel, Aman B. , Fuschi, Maurizio , Altschul, David , Investigators, for the WorldWideWEB, Salim, Hamza , Li, Yan-Lin , Algin, Oktay , Ghozy, Sherief , Guenego, Adrien , Shotar, Eimad , Lylyk, Ivan , Foreman, Paul M , Župančić, Vedran , Hafeez, Muhammad U , Ayberk, Giyas , Schirmer, Clemens M , Hassan, Ameer E , Nguyen, Anh , Jones, Jesse , Ulfert, Christian , Tawk, Rabih, Raz, Eytan , Griessenauer, Christoph J , Siddiqui, Adnan H , Levy, Elad I , Regenhardt, Robert W , Tjoumakaris, Stavropoula , Cuellar-Saenz, Hugo H , Jabbour, Pascal , Limbucci, Nicola , Altschul, David J , Dmytriw, Adam A , Dibas, Mahmoud , Pero, Guglielmo , Kalousek, Vladimir , Musmar, Basel , Essibayi, Muhammed Amir , Lay, Sovann V , Simonato, Davide , Zaccagna, Fulvio , Ghozy, Sherief , Renieri, Leonardo , Carnevale, Joseph Anthony , Saliou, Guillaume , Mastorakos, Panagiotis , Naamani, Kareem El, Shotar, Eimad , Möhlenbruch, Markus , Chung, Charlotte , Lylyk, Iván , Hafeez, Muhammad Ubaid , Catapano, Joshua S , Waqas, Muhammad , Kazancı, Atilla , Schirmer, Clemens M. , Piano, Mariangela , Kühn, Anna Luisa , Hassan, Ameer E , Psychogios, Marios‐Nikos , Huynh, Thien , Martinez-Gutierrez, Juan Carlos , Sheth, Sunil A , Tawk, Rabih G. , Pulli, Benjamin , Panni, Pietro , Puri, Ajit S , Griessenauer, Christoph J. , Levy, Elad I. , Cuellar, Hugo , Jabbour, Pascal , Limbucci, Nicola , Dmytriw, Adam A. , Investigators, for the WorldWideWEB
Interventional Neuroradiology | November 3, 2025 | Volume: No volume available | Issue: No issue available | Pages: No page available
Background The Woven EndoBridge (WEB) device represents an innovative solution for cerebral aneurysm occlusion, particularly for challenging wide-neck bifurcation aneurysms. However, factors affecting sustained occlusion remain poorly understood. We utilized machine learning to attempt to identify predictors of favorable long-term outcomes following WEB treatment. Methods In this multicenter retrospective study, we collected patient demographics, aneurysm characteristics, procedural details, and clinical outcomes. The primary endpoint was improvement in occlusion status, defined as maintained Raymond-Roy Occlusion Classification (RROC) grade 1, or improvement from grade 2 to 1, or from grade 3 to either 2 or 1 on final angiographic follow up. The dataset was split into training (75%) and validation (25%) sets. The CatBoost algorithm was selected based on performance metrics, with Shapley Additive exPlanations (SHAP) values calculated to determine feature importance. Furthermore, a multivariable binomial logistic regression model was performed to validate machine learning findings. Results Among 720 aneurysms from 36 hospitals, 84% showed improvement in occlusion at follow up. Both machine learning and multivariable logistic regression identified aneurysm height as the most consistent correlate of nonimprovement (odds ratio (OR) 0.90 per mm, p = 0.022). In the CatBoost model, the highest-ranking features by SHAP included aneurysm height, patient age, treatment acuity, ACom location, WEB-SLS device, bifurcation anatomy, aneurysm multiplicity, baseline modified Rankin Scale, access route, and partial thrombosis. Conclusions Machine-learning and regression analyses identified consistent predictors of occlusion improvement after WEB treatment, with aneurysm height most strongly linked to nonimprovement. These insights may guide patient selection and follow up. Findings require cautious interpretation and external validation in larger cohorts.
Safety and efficacy of preoperative embolization in the treatment of brain arteriovenous malformations with perinidal aneurysms and single draining vein: a multicenter study with propensity score-weighting
Adeeb, Nimer , Abdalrazeq, Hammam , Salim, Hamza , Tjoumakaris, Stavropoula , Kandregula, Sandeep , Ogilvy, Christopher S. , Sheehan, Jason , Aslan, Assala , Patel, Pious D. , Lan, Matthews , Baldassari, Michael P. , Koduri, Sravanthi , Atallah, Elias , Zeineddine, Hussein A. , Pontarelli, Mary-Katharine , Naamani, Kareem El, Ironside, Natasha , Gummadi, Sanjeev, Başkaya, Mustafa K. , Ataoglu, Cagdas , Mccarthy, Finn, Sanchez‐Forteza, Anthony , Essibayi, Muhammed Amir , Muram, Sandeep , Sconzo, Daniel , Riina, Howard A. , Rezai, Arwin, Alwakaa, Omar , Erginoğlu, Ufuk , Sen, Rajeev , Devia, Diego A., Perez-Mendez, Wilfran, Puentes, Juan C. , Spiotta, Alejandro M , Puri, Ajit S , Singh, Jasmeet, Burkhardt, Jan Karl, Starke, Robert M., Sekhar, Laligam N., Haranhalli, Neil , McAvoy, Malia , Eltiti, Marah, Abushehab, Abdallah, Foreman, Paul M. , Zaidat, Osama O. , Ruppert-Gomez, Marcella , Stapleton, Christopher J. , Koch, Matthew J. , Srinivasan, Visish M, Alshahrani, Rabab, Gooch, M Reid, Rosenwasser, Robert H. , Bulsara, Ketan R., Kan, Peter , Kim, Louis J. , Pukenas, Bryan , Li, Yan-Lin , Alaraj, Ali , Fuschi, Maurizio , Patel, Aman B. , Notarianni, Christina , Cuellar, Hugo H, Lawton, Michael T., Guthikonda, Bharat , Jabbour, Pascal , Salim, Hamza , Tjoumakaris, Stavropoula , Kandregula, Sandeep , Ogilvy, Christopher S , Dmytriw, Adam A , Aslan, Assala , Essibayi, Muhammed Amir , Alwakaa, Omar , Griessenauer, Christoph J , Abo Kasem, Rahim , Spiotta, Alejandro M , Levitt, Michael R , Altschul, David J , Shakir, Hakeem J , Zaidat, Osama O , Stapleton, Christopher , Koch, Matthew J , Chen, Peng R , Kan, Peter , Choudhri, Omar , Alaraj, Ali , Guthikonda, Bharat , Jabbour, Pascal , Erginoglu, Ufuk , Li, Yan-Lin , Burkhardt, Jan‐Karl , Musmar, Basel , Roy, Joanna M. , Kondziolka, Douglas , Dmytriw, Adam A. , Abou‐Al‐Shaar, Hussam , Naamani, Kareem El, Abdelsalam, Ahmed , Kumbhare, Deepak , Mccarthy, Finn, Keleş, Abdullah , Tos, Salem M , Mantziaris, Georgios , Park, Min S, Hanalıoğlu, Şahin , Pöppe, Johannes , Sen, Rajeev D, Griessenauer, Christoph J. , Ocampo-Navia, María Isabel , Kasem, Rahim Abo , Kühn, Anna Luisa , Sekhar, Laligam N. , Levitt, Michael R. , Altschul, David , Almajali, Mohammad , See, Alfred P. , Abla, Adib A. , Patel, Aashay , Nguyen, Andrew , Srinivasan, Visish M. , Blackburn, Spiros , Gooch, Michael Reid , Kim, Louis J. , Choudhri, Omar , Simonato, Davide , Savardekar, Amey Rajan , Lawton, Michael T. , Morcos, Jacques J.
Journal of NeuroInterventional Surgery | August 22, 2025 | Volume: 18 | Issue: 8 | Pages: 1765-1772
Background and objectives Arteriovenous malformations (AVMs) with perinidal aneurysms and single draining vein are associated with an elevated risk of rupture and increased procedural complexity. The role of preoperative embolization in this high-risk anatomical subset remains unclear. This study aimed to evaluate the safety and efficacy of microsurgery with preoperative embolization, compared with microsurgery alone in patients with such AVMs. Methods We conducted a multicenter retrospective analysis of an AVM registry from the MISTA (Multicenter International Study for Treatment of Brain AVMs) consortium and included AVMs with perinidal aneurysms and a single draining vein. Baseline characteristics, angiographic outcomes, functional outcomes, and complication rates were compared. Propensity score weighting (PSW) using the covariate balancing method was applied to adjust for baseline differences. Results Out of a total of 1919 patients, 65 met the inclusion criteria; 45 patients underwent preoperative embolization followed by microsurgery, and 20 underwent microsurgery alone. After adjustment, complete obliteration rates were similar between groups (OR 0.87, 95% CI 0.04 to 16.33, P=0.92), as were rates of functional independence at discharge and follow-up. Overall complication, symptomatic complication, and mortality rates did not differ significantly between groups. However, permanent complications were significantly lower in patients with preoperative embolization (OR 0.06, 95% CI 0.004 to 0.84, P=0.03). Discussion In patients with AVMs featuring perinidal aneurysms and single draining vein, preoperative embolization followed by microsurgery was associated with fewer permanent complications and no increase in adverse outcomes compared with microsurgery alone. However, given the small number of events, this finding should be interpreted cautiously.