Middle Meningeal Artery Embolization in the Treatment of Chronic Subdural Hematoma: A Two-Center Retrospective Study

<b>Background</b>: Chronic subdural hematoma (cSDH) is a common condition, particularly in individuals over 65 years of age. Its pathophysiology involves traumatic and inflammatory processes, culminating in hematoma formation. Although surgical drainage is the primary treatment of choice, its significant recurrence rates have prompted exploration of non-surgical options. This study evaluates the effectiveness of middle meningeal artery (MMA) embolization as an alternative or adjunctive treatment in asymptomatic or paucisymptomatic cSDH patients. <b>Methods</b>: This two-center retrospective study analyzed 93 patients treated with MMA embolization at two hospitals between 2020 and 2024. Patients exhibited either asymptomatic or mild symptomatic cSDH (Markwalder score 0 or 1), with hematoma thickness >10 mm. Pre- and post-treatment CT scans were compared to assess hematoma thickness, with follow-ups conducted at three months. Statistical analysis included ANCOVA and Mann-Whitney U tests for outcome evaluation. <b>Results</b>: Of the 93 patients, 44 underwent bilateral embolization, and 49 underwent unilateral embolization. Treatment reduced hematoma thickness by an average of 59% at three months follow-up. The trabecular subtype showed the greatest thickness reduction compared to other subtypes (<i>p</i> < 0.05). No significant differences were found between embolization materials. Only 3.2% of patients experienced technical complications, and three patients experienced rebleeding during follow-up. <b>Conclusions</b>: MMA embolization appears to be a safe and effective treatment for cSDH, providing a minimally invasive alternative to surgery. The technique shows promise in reducing hematoma size, especially in the trabecular subtype. Further research is needed to confirm these findings and establish their role in routine clinical practice.