Is Embolization a Safe Treatment Option for Certain Traumatic Subdural Hematomas?

Introduction. Middle meningeal artery (MMA) embolization is effective in chronic subdural hematoma (SDH), but its safety in acute SDH remains unclear. Authors of this study evaluated the safety of MMA embolization in acute SDH management. Methods. We conducted a retrospective review of adult acute SDH patients treated between July 2021 and July 2023 at a community-based Level I Trauma Center. Demographics, injury characteristics, treatments, and outcomes were compared between patients who did and did not undergo MMA embolization. Results. Records from 33 patients with acute SDH were reviewed: 17 underwent MMA embolization and 16 did not. Patients in the embolization group were older (median age 71.0 vs. 37.5 years). Minimal differences were observed between groups with respect to sex, race, or injury severity score. Non-embolized patients presented with a lower median Glasgow Coma Scale (GCS) score (11.5 vs. 14.0). Among the 17 embolized patients, 11 presented with acute bleeding and 6 with acute-on-chronic bleeding. Two patients in each subgroup required craniotomy prior to embolization. Of the remaining non-operatively managed patients, one underwent burr hole evacuation one day after embolization and was subsequently discharged to hospice. No patients required craniotomy after MMA embolization. Conclusions. MMA embolization appears to be a safe and potentially effective adjunct in the management of acute SDH, particularly in less severe cases. Larger, controlled studies are needed to better define its role and to determine whether it should be incorporated into standard treatment paradigms.