Clinical and Radiographic Course Following Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) is increasingly performed to reduce recurrence. Several recent randomized controlled trials, such as EMBOLISE, MAGIC-MT, and STEM, have shown significant interest in endovascular treatment of CSDH. Many studies have demonstrated clinical and radiographic outcomes following MMAE in different patient populations and treatment strategies, including stand-alone or adjunctive MMAE combined with surgical evacuation. Most studies have shown the efficacy of MMAE in reducing hematoma recurrence, reoperation rates, and even several adverse events compared with surgery alone. Moreover, stand-alone MMAE can be an efficacious and minimally invasive treatment option for some patients. However, its benefits on functional or radiographic outcomes vary depending on patient selection and treatment strategy. Furthermore, knowledge of periprocedural radiographic findings associated with hematoma resolution or reaccumulation after MMAE may contribute to a sufficient follow-up period after treatment, as well as to medical economics, and thus has clinical implications. In this review, we focus on the clinical and radiographic outcomes of MMAE for CSDH.