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Introduction Middle meningeal artery embolization (MMAE) using n-butyl cyanoacrylate has been demonstrated as an effective adjunct to surgical evacuation for chronic subdural hematoma (cSDH), yet the optimal timing of postoperative MMAE remains unclear. Evaluating whether MMAE timing impacts clinical outcomes is important for optimizing cSDH management.Materials and Methods This post hoc analysis of the randomized controlled MEMBRANE trial ( NCT04816591) evaluated if timing of MMAE relative to surgical evacuation influenced clinical outcomes in patients with cSDH. Outcomes were evaluated at or within 6 months and included reoperation, rehospitalization or death, and good functional outcome (modified Rankin Scale 0-2; if baseline ≥3, no worsening). This analysis compared participants undergoing MMAE 1-3 days post-surgery (early MMAE) versus 4-9 days post-surgery (late MMAE), with timing dichotomized at the median. Multivariable logistic regression analyses were performed for each outcome.Results A total of 82 participants underwent early MMAE and 48 underwent late MMAE. The mean (SD) age was 71.37 (10.14) years in the early MMAe group and 67.73 (11.51) years in the late MMAE group. Most participants in the early and late MMAE groups were male (74.4% and 79.2%, respectively). The mean (SD) screening hematoma volume was 127.16 (43.81) cm 3 in the early MMAE group and 134.96 (53.17) cm3 in the late MMAE group. Most participants in both the early and late MMAE groups received either a craniotomy/craniectomy (31.7% and 45.8%, respectively) or burr hole surgery (52.4% and 45.8%, respectively). Compared with the late MMAE group, the early MMAE group had numerically lower rates of reoperation within 6 months (2.5% [2/81) versus 4.4% [2/45]) and numerically lower rates of rehospitalization or death within 6 months (17.3% [14/81] versus 34.8% [16/46]). Good functional outcome at 6 months was achieved by 88.9% (64/72) of the early MMAE group and 85.4% (35/41) of the late MMAE group. In multivariable analyses, days between MMAE and surgery presented no evidence of association with reoperation within 6 months (odds ratio [95% confidence interval]: 1.103 [0.671-1.815]; P=0.6985) or good functional outcome (0.957 [0.690-1.328]; P=0.7945), but was associated with increased odds of rehospitalization or death (1.319 [1.040-1.673]; P=0.0224; figure 1).Conclusion Days between surgery and MMAE presented no evidence of association with reoperation or good functional outcomes at 6 months. However, a longer delay between surgery and MMAE was associated with higher odds of rehospitalization or death. These findings support further evaluation of postoperative MMAE timing to optimize clinical outcomes in cSDH management.Disclosures B. Jankowitz: 2; C; Johnson & Johnson MedTech Neurovascular, Medtronic, Balt, and Stryker. 3; C; Johnson & Johnson MedTech Neurovascular, Medtronic, Balt, and Stryker. S. Scarpiello: None. R. Gupta: 6; C; Johnson & Johnson MedTech Neurovascular (MEMBRANE study steering committee member), Medtronic (ELEVATE study steering committee member), Rapid Medical (PI for DISTALS study), ZOLL Medical (PI for RECCLAIM II study), Stryker Neurovascular (PI for ASSIST registry), and Penumbra (member of MIND study clinical events committee), Received royalties from UpToDate. R.M. Starke: 1; C; Neurosurgery Research & Education Foundation (research funding), Joe Niekro Foundation (research funding), Brain Aneurysm Foundation (research funding), Bee Foundation (research funding), Department of Health Biomedical Research Grant (Grant 21K02AWD-007000), National Institute of Health (through Miami Clinical and Translational Science Institute, Grants R01NS111119-01A1 and UL1TR002736, KL2TR002737), National Center for Advancing Translational Sciences and the National Institute on Minority Health and Health Disparities, Medtronic (unrestricted research grant), and Balt Group (unrestricted research grant). 2; C; Penumbra, Abbott, Medtronic, Balt Group, InNeuroCo, Johnson & Johnson MedTech Neurovascular, Microvention, Stryker, Zylox-Tonbridge, VON Medical, and Optimize Vascular. 3; C; Penumbra, Abbott, Medtronic, Balt Group, InNeuroCo, Johnson & Johnson MedTech Neurovascular, Microvention, Stryker, Zylox-Tonbridge, VON Medical, and Optimize Vascular. F. Al-Mufti: 2; C; Stryker Neurovascular, Johnson & Johnson MedTech Neurovascular, and Rapid AI. 3; C; Stryker Neurovascular, Johnson & Johnson MedTech Neurovascular, and Rapid AI. H. Shoirah: None. V. Srinivasan: 1; C; Zeiss, Medtronic, Stryker, Siemens. 2; C; Johnson & Johnson MedTech Neurovascular, Stryker, Imperative Care, IschemaView, Q’ Apel, Rapid Medical, National Football League. C. Matouk: 1; C; NIH (received grant R21NS128641). 2; C; Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. 3; C; Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. 4; C; CereVasc, Jiva Medical, and Neurofine. B. Yim: 2; C; Imperative Care, Stryker, Q’Apel, Kaneka, Terumo Neuro, Rapid Medical, and Penumbra. 3; C; Imperative Care, Stryker, Q’Apel, Kaneka, Terumo Neuro, Rapid Medical, and Penumbra. 6; C; Johnson & Johnson MedTech Neurovascular (principal investigator) and Kaneka (registry data source). M. Fusco: None. J. Wan: None. E. Liptrap: None. P. Bhuva: 2; C; Johnson & Johnson MedTech Neurovascular. 3; C; Johnson & Johnson MedTech Neurovascular. R. Grandhi: 2; C; Medtronic Neurovascular, Johnson & Johnson MedTech Neurovascular, Balt Neurovascular, and Stryker Neurovascular. 3; C; Medtronic Neurovascular, Johnson & Johnson MedTech Neurovascular, Balt Neurovascular, and Stryker Neurovascular. R. Cerejo: 6; C; iSchemaView (served as a member of advisory board). J. Liu: None. J. Cherian: None. Q. Zhang: None. C. Kellner: 1; C; Integra LifeSciences, Penumbra, Viz.ai, Siemens, Medtronic, Longeviti, IRRAS, iCE Neurosystems, CVAID, EndoStream, and MicroTransponder. 2; C; Route 92 Medical and Johnson & Johnson MedTech Neurovascular. 3; C; Route 92 Medical and Johnson & Johnson MedTech Neurovascular. 6; C; Precision Recovery, Borealis, E8, Borvo, and METIS Innovative (METIS Innovative is an investment group that has coordinated investments in Synchron, Proprio, Fluid Biomed, VonVascular.io, Precision Recovery, Phantom Neuro, Radical, Aurenar, and Reach Neuro). A. Rai: 2; C; Johnson & Johnson MedTech Neurovascular and Stryker. 3; C; Johnson & Johnson MedTech Neurovascular and Stryker.Abstract E-093 Figure 1