Use of Middle Meningeal Artery Embolization in Treatment of Chronic Subdural Hematoma

Introduction: Chronic subdural hematoma (cSDH) is a common neurosurgical condition in the elderly, frequently associated with trauma and antithrombotic therapy. Conventional surgical evacuation is effective but carries a significant risk of recurrence. Middle meningeal artery (MMA) embolization has recently emerged as a minimally invasive technique targeting the underlying vascular pathology of cSDH. This study aimed to assess the safety and efficacy of MMA embolization in the management of chronic subdural hematoma. Materials and Methods: This prospective observational study included 36 patients with radiologically confirmed cSDH who underwent MMA embolization, with or without surgical evacuation. Written informed consent was obtained and institutional ethical approval was secured. Clinical data, imaging findings, Glasgow Coma Scale (GCS), hematoma volume, recurrence, and need for re-surgery were recorded. Serial CT/MRI scans were performed postoperatively and during follow-up. Results: The mean age was 66.64 ± 13.10 years, with male predominance (88.89%). Headache was the most common presenting symptom (33.33%). Burr-hole evacuation was performed in 69.44% and craniotomy in 30.56%. Mean GCS improved significantly from 13.94 ± 1.37 on admission to 14.89 ± 0.32 at discharge (p = 0.0001). Subdural hematoma volume showed progressive and statistically significant reduction on both sides over follow-up (ANOVA p < 0.001). Conclusion: MMA embolization is a safe and effective adjunct in the treatment of chronic subdural hematoma, resulting in significant neurological improvement, sustained hematoma reduction, and low recurrence rates. It represents a promising minimally invasive strategy addressing the underlying pathophysiology of cSDH.