Clinical outcomes of middle meningeal artery embolization in trauma-related chronic subdural hematoma.

BACKGROUND: Middle meningeal artery (MMA) embolization has emerged as a promising therapeutic option in the management of chronic subdural hematoma (cSDH). However, data specifically focusing on trauma-related cSDH remain limited. This study aimed to evaluate the safety and clinical outcomes of MMA embolization in patients with trauma-related cSDH and to investigate radiological predictors of treatment success. METHODS: This retrospective study included patients with trauma-related cSDH who underwent MMA embolization at our institution between 2024 and 2025. Demographic, clinical, and radiological data-including midline shift (MLS) and hematoma thickness-were systematically collected. Functional outcomes were assessed using the modified Rankin Scale (mRS). Recurrence, need for surgical intervention, procedural complications, and mortality were recorded. Receiver operating characteristic (ROC) analysis was performed to evaluate the predictive value of midline shift for treatment failure. RESULTS: A total of 52 patients with a documented history of trauma were included. Embolization alone was performed in 43 patients (82.7%), whereas nine patients (17.3%) underwent combined embolization and surgical treatment. Preprocedural MLS was significantly greater in the embolization-plus-surgery group than in the embolization-only group (7.6±3.9 mm vs. 4.5±3.8 mm, p=0.03). No significant between-group differences were observed in residual hematoma thickness or MLS at 6 weeks (p>0.05). Functional out-comes improved at 90 days compared with baseline. An MLS threshold of 4.5 mm demonstrated the highest predictive accuracy for treatment failure, with a sensitivity of 78% and a specificity of 56%. CONCLUSION: MMA embolization appears to be a safe and clinically feasible treatment option for trauma-related cSDH. In carefully selected patients, it may serve as both an adjunct and an alternative to surgery. MLS may represent a practical and readily accessible parameter for risk stratification and patient selection. Prospective controlled studies are warranted to further validate these findings.