Middle meningeal artery arteriovenous shunting after surgical evacuation of chronic subdural hematoma: a retrospective angiographic cohort study.
M, G., F, F., A, H., W, R., & U, Y. (2026). Middle meningeal artery arteriovenous shunting after surgical evacuation of chronic subdural hematoma: a retrospective angiographic cohort study.. Neurosurgical review. https://doi.org/10.1007/s10143-026-04411-w
M G, F F, A H, W R, U Y. Middle meningeal artery arteriovenous shunting after surgical evacuation of chronic subdural hematoma: a retrospective angiographic cohort study.. Neurosurgical review. 2026; doi: 10.1007/s10143-026-04411-w
M G, F F, A H, et al. Middle meningeal artery arteriovenous shunting after surgical evacuation of chronic subdural hematoma: a retrospective angiographic cohort study.[J]. Neurosurgical review. 2026. DOI: 10.1007/s10143-026-04411-w.
@article{m2026,
author = {Garner M and Fries F and Haußmann A and Reith W and Yilmaz U},
title = {Middle meningeal artery arteriovenous shunting after surgical evacuation of chronic subdural hematoma: a retrospective angiographic cohort study.},
journal = {Neurosurgical review},
year = {2026},
doi = {10.1007/s10143-026-04411-w},
note = {PMID: 42477235},
}
TY - JOUR AU - Garner M AU - Fries F AU - Haußmann A AU - Reith W AU - Yilmaz U TI - Middle meningeal artery arteriovenous shunting after surgical evacuation of chronic subdural hematoma: a retrospective angiographic cohort study. T2 - Neurosurgical review PY - 2026 DO - 10.1007/s10143-026-04411-w AN - PMID:42477235 ER -
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.