Middle meningeal artery embolization as a stand-alone treatment for primary and recurrent chronic subdural hematoma

Objective Chronic subdural hematoma (cSDH) is one of the most common neurosurgical emergencies. Due to high percentage of hematoma reaccumulation middle meningeal artery (MMA) embolization arose as an alternative treatment option. Aim of this retrospective study is to present single center results of 97 stand-alone embolization procedures done during 3-year period. Methods Prospectively maintained database of all patients who underwent MMA embolization from December 2021 to March 2025 was retrospectively analyzed. Seventy-five asymptomatic or mildly symptomatic patients with 97 hematomas were included; 72 MMA embolization procedures were done as primary treatment in 55 patients, whereas cSDH recurrency was main indication for 25 procedures in 20 patients. Primary and recurrent cSDH groups were compared using Chi-square test. Results Mean follow-up period was 140 days. During the follow-up period 19/97 (19.6%) hematomas resorbed completely. Moreover, 21/97 (21.6%) of hematomas reduced in size more than 50%; 40 out of 97 embolized hematomas (41.2%) remained stable or were resorbed partially during follow up. Middle meningeal artery embolization failed in 14 cases (14.4%). We noted three cases of asymptomatic hematoma progression (3.1%). Three patients died during follow-up period. No statistically significant difference was shown between primary and recurrent cSDH cohort when compared based on percentage of complete hematoma resolution, treatment failure and rate of hematomas with >50% resorption. Conclusions Middle meningeal artery embolization is both safe and feasible stand-alone treatment option for cSDH, primarily for asymptomatic and minimally symptomatic patients with maximal hematoma tickness in the range between 10 and 20 mm.