Feasibility of middle meningeal artery embolization following large craniotomy: A case series

IntroductionWhile middle meningeal artery embolization (MMAE) has been shown to be feasible for recurrent subdural hematoma (SDH) after craniotomy, large traumatic craniotomies exceeding 8000 mm² have typically been excluded. In this novel case series, we assess the feasibility and efficacy of MMAE in treating recurrent SDH following large open neurosurgical intervention (non-burr hole or bedside procedures). In all cases, a portion of the middle meningeal artery (MMA) territory remained patent and was successfully embolized.MethodsWe identified five cases of recurrent SDH who underwent MMAE after ipsilateral or contralateral craniotomy at a single institution between 2020 and 2023. Burr hole and bedside craniotomies were excluded. Demographic, clinical, and operative data were collected and presented.ResultsFive patients underwent MMAE following large frontotemporoparietal craniotomies for SDH evacuation (mean size: 10,938 mm²). Both transradial and transfemoral approaches were used, and technical success was achieved in all five patients. In each case, a minimum of the posterior division of the MMA was patent and embolized. No complications were observed.ConclusionsThis case series provides preliminary evidence that MMAE is feasible and effective even after large frontotemporoparietal craniotomy. Neurointerventionalists should not exclude patients with craniotomies exceeding 8000 mm² from consideration for MMAE to treat ipsilateral recurrent SDH.