Middle meningeal artery embolization for chronic subdural hematoma using PHIL-LV: A case series

BackgroundChronic subdural hematoma (CSDH) is increasingly treated with middle meningeal artery embolization (MMAE). This study evaluated MMAE using a precipitating hydrophobic injectable liquid low viscosity (PHIL-LV) liquid embolic agent under general anaesthesia.MethodsConsecutive patients who underwent MMAE for CSDH with PHIL-LV at a single comprehensive neuroscience centre during a two-year period (2023-2025) were analysed. Patient clinical characteristics, imaging characteristics and procedural characteristics were recorded and described.ResultsTwenty-two patients (mean age 76 ± 13) were included in this study. Mean CSDH size was 18.4 ± 6.7 mm; 9/22 (40.9%) patients had a Charlson Comorbidity index >4. MMA embolization was successful in all 22/22 (100%) patients. Symptomatic improvement was observed in 14/17 (82.4%) of patients. During mean follow up (10.7 ± 9.2 (range 1-36)) weeks, mean reduction in CSDH thickness was 12.1 ± 9.9 mm; 13/16 (81.3%) patients had at least partial radiologic resolution of CSDH. No patients required retreatment.ConclusionPHIL-LV MMAE was safe and effective for treatment of CSDH in this case series.