Middle meningeal artery embolization expansion for treating acute and acute-on- subacute subdural hematomas

<h3></h3> Middle meningeal artery embolization is an innovative procedure employed in the management of chronic subdural hematomas. The technique involves obstructing blood flow to the dura mater. In cases of chronic bleeding, the outer membranes of subdural hematomas often exhibit fragile neovascularizations induced by inflammatory markers. These neovascularizations frequently lead to the leakage of blood products into the chronic hematoma, causing its expansion. We identified patients with acute or acute-on-subacute subdural hematomas who had pre-existing conditions necessitating expedited embolization. This category included patients with prior strokes on antiplatelet agents or anticoagulation. These individuals were specifically targeted due to the risk of recurrent stroke when temporarily off their antiplatelet agents or anticoagulation due to hematoma expansion. Therefore, we present a pilot study involving six high-risk patients who underwent middle meningeal artery embolization in the acute or subacute setting to proactively neutralize the subdural hematoma and prevent its expansion. All cases exhibited progressive improvement in the subdural hematoma post-operatively without re-expansion.