{
  "abstract": "Background The 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 therapiesMethods Over 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 committeeResults Randomized 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 recurrencesConclusion The MMA represents a vascular pathway for an expanding spectrum of neurointerventional therapies.",
  "authors": [
    {
      "affiliations": [
        "Neurology, Neurosurgery and Radiology, Interventional Neuroradiology/Endovascular Neurosurgery Division, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA"
      ],
      "name": "Edgar A Samaniego"
    },
    {
      "affiliations": [
        "Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA",
        "Neurological Surgery, University of California San Francisco, San Francisco, California, USA"
      ],
      "name": "Luis Savastano"
    },
    {
      "affiliations": [
        "Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA"
      ],
      "name": "Matthew Robert Amans"
    },
    {
      "affiliations": [
        "Neurosurgery, Montefiore Medical Center, Bronx, New York, USA"
      ],
      "name": "David Altschul"
    },
    {
      "affiliations": [
        "Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA"
      ],
      "name": "Mark Bain"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology and Neuroendovascular Surgery, Miami Neuroscience Institute and Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, Florida, USA"
      ],
      "name": "Guilherme Dabus"
    },
    {
      "affiliations": [
        "Neurosurgery, Stony Brook Medicine, Stony Brook, New York, USA"
      ],
      "name": "David Fiorella"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Utah Health, Salt Lake City, Utah, USA"
      ],
      "name": "Ramesh Grandhi"
    },
    {
      "affiliations": [
        "Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA"
      ],
      "name": "Violiza Inoa-Acosta"
    },
    {
      "affiliations": [
        "Radiology, Mayo Clinic, Rochester, Minnesota, USA"
      ],
      "name": "Ramanathan Kadirvel"
    },
    {
      "affiliations": [
        "Neurosurgery, Mount Sinai, New York, New York, USA"
      ],
      "name": "Christopher Paul Kellner"
    },
    {
      "affiliations": [
        "Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA"
      ],
      "name": "Jose Morales"
    },
    {
      "affiliations": [
        "Neurology, UPMC Stroke Institute, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Raul G Nogueira"
    },
    {
      "affiliations": [
        "Neurosurgery, Baylor College of Medicine, Houston, Texas, USA"
      ],
      "name": "Akash Patel"
    },
    {
      "affiliations": [
        "Neurology, University of Missouri, Columbia, Missouri, USA"
      ],
      "name": "Adnan I Qureshi"
    },
    {
      "affiliations": [
        "Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA",
        "Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA"
      ],
      "name": "Adam S Arthur"
    },
    {
      "affiliations": [
        "Radiology, Tufts Medical Center, Boston, Massachusetts, USA"
      ],
      "name": "Ajay K Wakhloo"
    },
    {
      "affiliations": [
        "Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA"
      ],
      "name": "Peter Kan"
    },
    {
      "affiliations": [
        "Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA"
      ],
      "name": "ARISE Consortium III"
    }
  ],
  "title": "Middle meningeal artery as a pathway to innovative treatments: ARISE III consensus recommendations",
  "uid": "f991f169-3fac-5373-a17e-e9905a30ebd4"
}