Embolization of the Middle Meningeal Artery As Primary Treatment for Chronic Subdural Hematoma in Older Filipino Adults

Chronic subdural hematoma (CSDH) is among the most common neurosurgical conditions in older adults, traditionally managed with burr-hole drainage, which may be associated with recurrence and perioperative risks. Embolization of the middle meningeal artery (EMMA) has recently emerged as a minimally invasive alternative with promising safety and efficacy profiles. This case series describes the institutional experience with EMMA as a primary treatment for CSDH in older Filipino adults managed in a government tertiary hospital. The majority of patients demonstrated radiographic improvement, and most showed clinical recovery without major complications. Anatomical factors, such as vessel caliber and completeness of branch embolization, appeared to influence treatment outcomes. These early findings suggest that EMMA is a feasible and potentially effective option for older adults with CSDH, particularly for those with comorbidities that increase surgical risk. Larger prospective studies are warranted to further define its role in low- and middle-income settings.