Role of middle meningeal artery embolization in the treatment of chronic subdural hematoma

Abstract

Background Chronic subdural hematoma (cSDH) is a common neurosurgical condition, particularly among older adults, and is associated with substantial morbidity and recurrence after surgical evacuation. Middle meningeal artery (MMA) embolization has emerged as a minimally invasive treatment intended to reduce the vascular supply to the hematoma membranes. This study evaluated preliminary short-term radiological and treatment outcomes after MMA embolization in patients with symptomatic cSDH. Methods This prospective, single-arm, single-center study enrolled 10 patients with symptomatic cSDH who underwent MMA embolization at Kafr Elsheikh University between October 2024 and October 2025. Eligible patients included those with mild neurological symptoms, high surgical risk, recurrent or refractory hematomas, or failure of conservative management. MMA embolization was performed through femoral or radial arterial access using polyvinyl alcohol particles or a liquid embolic agent. Clinical assessment and non-contrast computed tomography were performed after the procedure and at 2 and 6 weeks. Results Bilateral hematomas were present in 4(40%) patients. At 2 weeks, 7(70%) patients demonstrated a reduction in hematoma size of at least 50%; complete disappearance was subsequently documented in 2 of these 7 patients. Inadequate hematoma resolution necessitated post-embolization surgical evacuation in 3(30%) patients; therefore, 7(70%) patients did not undergo subsequent surgery during the 6-week follow-up. Procedure-related complications occurred in 2(20%) patients: one femoral puncture-site groin hematoma that resolved with conservative management and one MMA dissection without clinical sequelae. No other procedure-related adverse events were reported. Conclusion MMA embolization was associated with substantial short-term radiological reduction of cSDH. Seven of 10 patients demonstrated a reduction in hematoma size of at least 50% at 2 weeks, and 7/10 patients did not require subsequent surgical evacuation during 6 weeks of follow-up. Two procedure-related complications were observed: one groin hematoma that resolved with conservative management and one MMA dissection without clinical sequelae.