OBJECTIVE Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases. Middle meningeal artery embolization (MMAE) is a treatment option in addition or as an alternative to conservative or surgical therapy. The objective of this study was to investigate whether MMAE can be used as a primary treatment method in patients with CSDH without an acute indication for surgery, and as a therapeutic option instead of a reoperation in cases of recurrence after surgery. METHODS Fifty-one patients with MMAE as the primary treatment method for CSDH or for cases of recurrence after surgical treatment were prospectively included. A retrospective matching with patients treated only surgically was performed using the criteria of age, gender, size and side of the CSDH, as well as anticoagulation therapy. In the follow-up, the frequency of rescue operations and complications and the resumption of anticoagulation treatment were analyzed. RESULTS Eleven patients with MMAE and 14 controls underwent rescue surgery due to relevant worsening of symptoms (p = 0.638). None of the patients with MMAE experienced a complication, compared with 7 of the controls (p = 0.012). When anticoagulation treatment was resumed, there was a tendency in favor of MMAE (p = 0.058). CONCLUSIONS There is a tendency toward superiority of MMAE for CSDH in certain patients. However, uncertainties remain regarding the exact methodology and optimal indications, and further research will be needed.
Michael et al. (2025) studied this question.