EXPRESS: Middle Meningeal Artery Embolization: Expansion of Therapeutic Applications Driven by Neurovascular-Immune Mechanisms

BACKGROUND: Middle meningeal artery embolization (MMAE) has rapidly evolved from a procedure targeting specific vascular pathologies into a versatile therapeutic strategy with expanding indications across neurological diseases. However, the biological mechanisms underlying its cross-disease efficacy remain poorly defined. METHODS: We synthesized experimental and clinical studies across emerging MMAE indications, including chronic subdural hematoma, migraine, and glioblastoma, with a focus on identifying shared neurovascular-immune mechanisms. RESULTS: Emerging evidence suggests that the middle meningeal artery (MMA) functions as a neurovascular-immune interface that integrates nociceptive signaling, neurogenic inflammation, pathological angiogenesis, and meningeal immune regulation. Within this framework, MMAE exerts therapeutic effects beyond vascular occlusion by disrupting pathological blood supply, attenuating neurogenic inflammation, modulating aberrant angiogenesis, and reshaping the meningeal immune microenvironment. These coordinated actions provide a unifying mechanistic basis for its efficacy across distinct disease contexts. CONCLUSIONS: This review proposes an integrated conceptual framework linking MMAE to neurovascular-immune regulation, thereby advancing its understanding as a strategy for modulating disease-relevant microenvironmental interactions across neurological disorders.