Comparing outcomes for middle meningeal artery embolization on traumatic non-acute subdural hematomas in surgical and non-surgical patients

Background and Objectives Middle meningeal artery embolization (MMA embolization) is a minimally invasive procedure thought to safely lower the risk of hematoma progression and recurrence. This study aims to assess patients admitted with traumatic subacute/chronic SDH and compare clinical outcomes for surgical and non-surgical patients who underwent MMA embolization. Methods Patients with traumatic brain injuries admitted between 2022 and 2024 were extracted from the internal trauma registry. Chart reviews were conducted to identify patients with non-acute SDH and to identify patients who underwent MMA embolization (MMA group) and those who did not (no MMA group). Baseline demographic, clinical presentation, and radiographic data were collected. Subanalyses were done for surgical patients and nonsurgical patients. Results For this study, a total of 36 patients were identified for the MMA group (18 surgical and 18 non-surgical) and 70 for the no-MMA group (17 surgical and 53 nonsurgical). In the analysis of surgical patients, there were no statistically significant differences in baseline patient characteristics or clinical presentation. All outcomes and radiological findings were similar as well, with the exception of the repeat surgery rate, which was higher in the no MMA group (0% vs 18%; p = .06). In the analysis of non-surgical patients, from hospital admission to the 3-month mark, the SDH thickness for the MMA group decreased significantly more than for the no MMA group (−4 mm vs −0.5 mm; p = .01). Additionally, the mortality rate for the no MMA group was significantly higher (0% vs 19%; p = .047). Conclusion Our study demonstrates that MMA embolization is associated with significantly reduced SDH thickness in non-surgical patients but not surgical patients. MMA embolization may be associated with a lower repeat surgery rate in non-acute SDH patients. More research should be conducted on the efficacy of MMA embolization in this patient population.