Middle meningeal artery embolization reduces recurrence in subdural hematoma management

Objectives To compare the efficacy and safety of conventional surgical management versus combined management with middle meningeal artery embolization or exclusively endovascular treatment in patients with symptomatic non‐acute subdural hematoma. Materials and Methods Multicenter retrospective cohort study conducted in Colombia (January 2020‐June 2025). Patients older than 18 years, previously functional (mRS <3), with symptomatic non‐acute subdural hematoma were included. Data were obtained from an anonymized secondary clinical database. Four treatment groups were defined: surgery alone, surgery + embolization, embolization alone, and conservative management. Results A total of 145 patients corresponding to 179 hematomas were included. Per hematoma, recurrence was higher in surgery alone n=21 (28.4%) and embolization alone n=12 (33.3%) compared to the combined group n=8 (11.6%) (p=0.014). The need for surgical reintervention was also more frequent in surgery alone n=14 (18.9%) compared to the combined group n=6 (8.7%), without statistical significance (p=0.129). Per patient, 90‐day readmission was more common in surgery alone (38.6%) and embolization alone (12.5%) compared to the combined group (7.8%) (p<0.000). Favorable functional outcome at discharge (mRS 0‐2) was achieved in 92.2% of the combined group, 71.9% of surgery alone, and 93.8% of embolization alone (p<0.007). Hematoma thickness delta was greater in surgery alone (‐9.79 mm) and combined (‐6.41 mm), while embolization alone showed an increase (+0.42 mm). Conclusions Combined management was associated with lower hematoma recurrence, fewer readmissions, and better functional outcomes compared with surgery alone.