Journal article
Middle meningeal artery as a pathway to innovative treatments: ARISE III consensus recommendations
Journal of neurointerventional surgery
05/07/2026
DOI: 10.1136/jnis-2026-025150
PMID: 42097871
Abstract
BackgroundThe middle meningeal artery (MMA) has emerged as an endovascular route for treating chronic subdural hematoma (CSDH), meningioma, and refractory headaches. The third ARISE roundtable convened experts from neurology, neurosurgery, neuroradiology, industry, and regulatory agencies to develop consensus guidance on current evidence for MMA-based therapiesMethodsOver 50 experts participated in a multi-stakeholder discussion. Evidence from randomized and observational studies, early-phase interventional series, and preclinical work was reviewed. Breakout groups focused on four domains: (1) MMA embolization (MMAE) for CSDH, (2) preoperative embolization of meningiomas, (3) MMA-targeted therapies for headache, and (4) transvascular access for endovascular drainage of subdural hematomas. Consensus recommendations were developed by a writing committeeResultsRandomized trials support MMAE as an adjunct to surgery or medical management for selected patients with non-acute, symptomatic CSDH to reduce recurrence, progression, and reoperation. Evidence remains insufficient to support MMAE for acute or asymptomatic subdural hematomas. For meningioma, observational data suggest that preoperative embolization in experienced centers can reduce blood loss and operative time and may delay recurrence in large, hypervascular tumors with predominant dural or external carotid supply; primary embolization and intra-arterial oncologic therapies remain investigational. Early series of MMA-directed lidocaine infusion for refractory migraine, status migrainosus, and post-subarachnoid hemorrhage headache show short-term benefit, highlighting the need for controlled trials. Preclinical and first-in-human studies of combined MMAE and transvascular drainage for CSDH demonstrate high technical success, rapid radiographic and clinical improvement, and no early recurrencesConclusionThe MMA represents a vascular pathway for an expanding spectrum of neurointerventional therapies.
Details
- Title: Subtitle
- Middle meningeal artery as a pathway to innovative treatments: ARISE III consensus recommendations
- Creators
- Edgar A Samaniego - University of Iowa Hospitals and ClinicsLuis Savastano - University of California, San FranciscoMatthew Robert Amans - University of California, San FranciscoDavid Altschul - Montefiore Medical CenterMark Bain - Cleveland ClinicGuilherme Dabus - Baptist Hospital of MiamiDavid Fiorella - Stony Brook MedicineRamesh Grandhi - University of UtahVioliza Inoa-Acosta - Semmes Murphey FoundationRamanathan Kadirvel - Mayo ClinicChristopher Paul Kellner - Icahn School of Medicine at Mount SinaiJose Morales - University of Arkansas for Medical SciencesRaul G Nogueira - UPMC Health SystemAkash Patel - Baylor College of MedicineAdnan I Qureshi - University of MissouriAdam S Arthur - University of Tennessee Health Science CenterAjay K Wakhloo - Tufts Medical CenterPeter Kan - The University of Texas Medical Branch at GalvestonARISE Consortium - The University of Texas Medical Branch at Galveston
- Resource Type
- Journal article
- Publication Details
- Journal of neurointerventional surgery
- DOI
- 10.1136/jnis-2026-025150
- PMID
- 42097871
- NLM abbreviation
- J Neurointerv Surg
- ISSN
- 1759-8478
- eISSN
- 1759-8486
- Publisher
- BMJ Publishing Group Ltd
- Language
- English
- Electronic publication date
- 05/07/2026
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9985163543402771
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