Middle Meningeal Artery Embolization for Chronic Subdural Hematomas: Current Evidence, Practice, and Future Directions

Chronic subdural hematoma (cSDH) is one of the most prevalent neurosurgical conditions in the aging population and is believed to involve a self-perpetuating inflammatory cycle that leads to neo-membrane formation and leaky neovascularization. Traditional treatment via surgical drainage effectively evacuates the hematoma but often fails to prevent recurrence due to unresolved underlying inflammation. Recently, middle meningeal artery embolization (MMAE) has emerged as a minimally invasive technique that targets the membranes to reduce recurrence. Early studies and meta-analyses suggest that MMAE significantly lowers recurrence rates and the need for reoperation compared with surgery alone. Recent and ongoing clinical trials, including EMBOLISE, STEM, and MAGIC, have reported preliminary favorable outcomes; thus, MMAE may be poised to become the standard of care for adjuvant management following surgical drainage of cSDH.