Middle meningeal artery embolization versus standard of care for chronic subdural hematoma: Meta-analysis of randomized controlled trials.

Introduction Chronic subdural hematomas (SDH) are common in older adults due to increased risks of falls, cerebral atrophy, and antithrombotic therapy, leading to higher bleeding risks. Current randomized clinical trials are evaluating the safety and efficacy of middle meningeal artery (MMA) embolization for chronic SDH. These trials, such as EMBOLISE, MAGIC‐MT, and STEM, have reported preliminary promising results using different embolic agents. This study examines the safety and efficacy of MMA embolization using liquid embolic materials and coils at a single institution, comparing outcomes with the aforementioned trials. Methods We conducted a retrospective review of 66 patients who underwent MMA embolization for subacute and chronic SDH at a single institution from February 2021 to March 2024. Data were collected from electronic medical records, including demographics, clinical data, imaging, procedural details, use of antiplatelet or anticoagulation medications, and outcomes at discharge and follow‐up. Patients aged 18 or older with subacute or chronic SDH who underwent MMA embolization were included. Follow‐up assessments were conducted at multiple intervals post‐procedure. Descriptive statistics were used for data analysis. Results The median age of the cohort was 71 years, with a predominance of males (64.71%) and African Americans (54.90%). Eighteen patients had prior SDH interventions, and 62.75% were on antithrombotic therapy before diagnosis. The median time from symptom onset to diagnosis was one day, with most SDHs being traumatic (60.78%). Elective MMA embolizations were performed in 64.71% of cases, primarily using a femoral approach. N‐butyl cyanoacrylate (n‐BCA) was used in 97.37% of procedures, and coils in 27.63%. Complications were rare, with two cases (3.92%) of MMA rupture and access site hematoma. The technical success rate was 97.37%. The median hospital stay was seven days, with most patients discharged home (70.59%). The in‐hospital mortality rate was 1.96%, with seven post‐discharge deaths unrelated to MMA embolization or SDH. The median follow‐up duration was 130 days, with two patients (3.92%) requiring repeat MMA embolization and three (5.88%) needing SDH evacuation. Compared to EMBOLISE, MAGIC‐MT, and STEM trials, our study showed a recurrence rate of 9.8% for all patients, with 6.45% in the MMA embolization alone group and 15% in the surgery with adjunctive MMA embolization group. EMBOLISE reported a 4.10% recurrence rate with surgical evacuation with adjunctive MMA embolization, MAGIC‐MT showed 1.90% recurrence with MMA embolization alone and 4.70% with surgery and adjunctive MMA embolization, and STEM found 19.10% recurrence with MMA embolization alone and 12.30% with surgery with MMA embolization. Discussion Our study suggests that selective distal embolization using n‐BCA is effective, with a low complication rate. Distal embolization may prevent cranial nerve injuries and strokes associated with proximal embolizations. The ongoing trials will provide further insights into optimal embolization sites and agents, and the timing for restarting anticoagulation. Conclusion MMA embolization using liquid embolic materials and coils is a promising treatment for subacute and chronic SDH, with low recurrence and complication rates. Comparison with current trials indicates favorable outcomes. Further research is needed to refine embolization techniques and optimize patient management strategies, potentially revolutionizing chronic SDH treatment.

The purpose of this review is to present a brief background on chronic subdural hematomas (cSDH), middle meningeal artery (MMA) embolization, and its role in decreasing recurrence of cSDH. A review of the most up-to-date literature should demonstrate the efficacy of this procedure. The latest data shows that MMA embolization is a safe procedure, with low complication rates and low recurrence rates. While cSDH managed with surgical evacuation can have a recurrence rate upwards of 30%, MMA embolization alone or as an adjunct to surgery decreases recurrence to less than 5% in most studies. MMA embolization can be especially useful in high-risk populations such as the elderly, patients on anti-platelet medication, and those with coagulopathies. It can also be done awake, done without general anesthesia, and is significantly less invasive than traditional surgical techniques. In reviewing the literature on MMA embolization, it is clear that there are numerous retrospective studies and systematic reviews demonstrating its safety and efficacy, and some prospective dual-arm studies that present novel information. The numerous clinical trials that are currently underway should help to further establish MMA embolization as standard of care in the management of cSDH.

Introduction Chronic subdural hematoma is a disease encountered in elderly populations with cited frequencies of 1.7‐20.6 patients per 100,000 people yielding significant morbidity and mortality (Feghali). It is associated with a 5‐30% recurrence rate despite surgical evacuation (Kan). The pathophysiology involves a complex inflammatory reaction leading to angiogenesis and continued hematoma expansion (Holl). The traditional management of cSDH has historically been neurosurgical drainage either with craniotomy, Burr holes, or craniectomy (Mehta). These treatment techniques however, have been associated with higher rates of recurrence when compared to MMA embolization (Ironside). MMA embolization is a newer technique being offered to patients for management of cSDH that has proven to be highly effective (Catapano). Several recent studies comparing MMA embolization to traditional surgical treatment are beginning to show improved clinical outcomes, hospital days, recurrence rates, and complications (Srivatsan, Ban). Methods We collected all data regarding MMA embolization for patients with cSDH between March 2019 and August 2024 admitted to a single comprehensive stroke center in Thousand Oaks, CA. Demographic data, neurologic deficits, and radiologic reports were obtained through the electronic medical record. Procedural details were noted including any periprocedural complications, as well as the need for any surgical intervention. Repeat radiologic findings were reported, in addition to pertinent events that occurred during hospitalization and disposition. Major complications reported were periprocedural stroke, perioperative bleeding requiring transfusion, catheter detachment, and vascular dissection. Minor complications included contrast allergy and groin hematoma. Results 120 patients were admitted for cSDH and treated with MMA embolization. 34% of patients were female. Comorbidities include hypertension, diabetes mellitus, atrial fibrillation in 20%, 62%, and 14%, respectively. 30% of patients were receiving antithrombotics prior to the procedure (antiplatelets and dual oral anticoagulants). 39% were right‐sided SDH, 34% left‐sided SDH, and 27% bilateral SDH. Average size was 13.8mm and 4.8mm midlife shift. 71% of patients were treated with bilateral MMA embolization and 29% were treated with unilateral MMA embolization. Decision to treat bilateral or unilateral MMA embolization depended on neurointerventionalist preference. 52% of cases required surgical evacuation as well. There were 0 major complications and 0 minor complications. Average length of stay was 12 days and 42% of patients were discharged to home. Conclusions Our single center retrospective review of MMA embolization demonstrated that the procedure is safe indicated by our low complication rates. With the increased use of antithrombotic medications in an aging population, the frequency of chronic subdural hematomas is anticipated to expand, and MMA embolization offers a safe treatment option to prevent recurrence. This project contributes to growing fund of research for MMA embolization becoming the standard of care for cSDH.

Middle meningeal artery (MMA) embolization has been proposed as a potential treatment for chronic subdural hematoma (CSDH). To assess the efficacy of MMA embolization in reducing the risk of CSDH recurrence at 6 months compared with standard care in patients who underwent an operation and were at high risk of CSDH recurrence. Multicenter, open-label, randomized clinical trial with blinded end point assessment. Patients who underwent an operation for CSDH recurrence or a first CSDH episode at high risk of recurrence were recruited from July 2020 to March 2023 in 12 French neurosurgical or comprehensive neurosurgical and interventional neuroradiology centers. Last follow-up took place on November 2, 2023. Participants were randomized 1:1 to undergo MMA embolization with microparticles within 7 days of surgery (171 patients, intervention group) or standard medical care alone (171 patients, control group). The primary end point was the rate of CSDH recurrence at 6 months assessed by an independent, blinded adjudication committee. There were 5 secondary end points, including rates of repeat surgery for homolateral CSDH recurrence during the 6-month follow-up period and embolization procedure-related complications. Among 342 randomized patients (median [IQR] age, 77 [68-83] years; 274 [80.1%] male), 308 (90.1%) completed the trial. The primary end point was observed in 24 of 162 (14.8%) and 33 of 157 (21.0%) patients in the intervention and control groups, respectively (after imputation: odds ratio, 0.64 [95% CI, 0.36-1.14]; adjusted absolute difference, -6% [95% CI, -14% to 2%]; P = .13). The groups did not significantly differ in any of the secondary end points. Repeat surgery was performed in 7 of 162 (4.3%) and 13 of 157 (8.3%) patients in the intervention and control groups (P = .14), respectively. Minor and major embolization procedure-related complications occurred in 3 of 171 (1.8%) and 1 of 171 (0.6%) patients, respectively. In this randomized clinical trial, among patients who underwent an operation for CSDH recurrence or a first CSDH episode at high risk of recurrence, MMA embolization did not lead to a significantly lower rate of recurrence at 6 months compared with standard medical care alone. However, the magnitude of the effect estimate is consistent with other recent trials, including some that demonstrated the benefit of MMA embolization with nonadhesive liquid embolic agents, and these findings considered together may inform future studies and potential use of this therapeutic approach for CSDH management. ClinicalTrials.gov Identifier: NCT04372147.

Background: Chronic subdural hematoma (cSDH) is a common neurosurgical condition, particularly among elderly patients. Middle meningeal artery (MMA) embolization has emerged as a minimally invasive adjunctive treatment aimed at reducing recurrence. However, its comparative efficacy and safety remain under investigation. Methods: In this systematic review and meta-analysis, randomized-controlled clinical trial (RCT) data evaluating MMA embolization combined with best medical therapy (BMT) versus BMT alone in adult patients with symptomatic cSDH were pooled. The primary efficacy outcome was recurrence or progression of hematoma at follow-up. Secondary efficacy outcomes included good functional outcome [modified Rankin Scale (mRS) score ≤ 2], independent ambulation (mRS score ≤ 3), and hematoma thickness at follow-up. The primary safety outcome was all-cause mortality. Procedure-related complications were assessed as a secondary safety outcome. Results: Six RCTs were included, comprising 760 patients treated with MMA embolization and 788 patients treated with BMT alone. MMA embolization significantly reduced recurrence compared to BMT alone (RR: 0.50; 95% CI: 0.37-0.69; six studies; I2 = 0%; number-needed-to-treat = 13). No significant differences were observed in good functional outcome (RR: 1.01; 95% CI: 0.97-1.05; three studies; I2 = 0%), independent ambulation (RR: 1.01; 95% CI: 0.99-1.04; three studies; I2 = 0%), or hematoma thickness at follow-up (SMD: -0.1; 95% CI: -0.3 to 0; four studies; I2 = 42%). All-cause mortality was similar between the two groups (RR: 1.01; 95% CI: 0.42-2.40; five studies; I2 = 44%). The pooled rate of procedure-related adverse events in the MMA embolization-group was 1% (95% CI: 0-3%; two studies; I2 = 35%). Conclusions: MMA embolization significantly reduced cSDH recurrence when used as an adjunct to BMT. However, it did not demonstrate a significant impact on functional outcomes or mortality in this meta-analysis. Further research is needed to identify patient subgroups that benefit most from MMA embolization and to evaluate its impact on cognitive function and quality of life using longer follow-up periods.

Middle meningeal artery (MMA) embolization is a minimally invasive treatment option for new and recurrent chronic subdural hematomas (cSDH). To examine the safety and efficacy profile of MMA embolization without surgical evacuation for cSDH patients. A single-center retrospective study of patients with cSDHs treated by MMA embolization was undertaken. Patient demographics, hematoma characteristics, procedural details, and clinical and radiological outcomes were collected. The primary outcome was the need for retreatment, and the secondary outcomes were at least a 50% reduction in the maximum width of cSDH on the last CT imaging, complications, and an improvement in the modified Rankin scale (mRS) score. All results were presented as descriptive statistics. A total of 209 MMA embolizations were successfully performed on 144 patients. Polyvinyl alcohol particles were the primary embolization agent in all procedures. Of the total of 206 cSDH, the median maximum width at pre-intervention and last follow-up were 12 and 3 mm, respectively, and the median reduction percentage was 77.5%, with a >50% improvement observed in 72.8% at the last follow-up imaging. A total of 13.8% of patients needed retreatment for recurrent, refractory, or symptomatic hematomas after embolization. The mRS score improved in 71 (49.3%) patients. Of 144 patients, 4 (2.8%) experienced complications related to the procedure, and 12 (8.4%) died during follow-up due to causes unrelated to the MMA embolization procedures. This study supports the fact that MMA embolization without surgical evacuation is a safe and effective minimally invasive option for the treatment of cSDHs.

Selection of an embolic agent for middle meningeal artery embolization (MMAE) in a chronic subdural hematoma (cSDH) is a subject of debate and is limited to observational data. We report the first meta-analysis that exclusively assessed randomized controlled trials (RCTs) to address this gap. A systematic review and meta-analysis was conducted, incorporating all available RCTs that compared MMAE plus standard of care (SOC) versus SOC alone for cSDH usingeither Onyx, n-BCA, and Squid as embolic agent for embolization. Primary outcomes were the rate of hematoma recurrence/progression and the need for reoperation. Secondary outcomes included serious adverse events (SAE), all-cause mortality, functional independence (defined as a Modified Rankin Scale (mRS) score of 0-2), and the rate of successful embolization. To assess heterogeneity, a fixed-effect or random-effects model was applied, depending on statistical significance (I²>50%, P < 0.1). Four RCTs, with 894 patients in the MMAE plus SOC group and 914 patients in the SOC alone group, were identified and met our standard for analysis. Results revealed significant superiority of n-BCA compared to Onyx and Squid in lower all-cause mortality at last follow-up. There was no significant difference in using Onyx, Squid, and n-BCA in recurrence at the last follow-up (P = 0.36), reoperation at the last follow-up (P = 0.55), and successful embolization (P = 0.52), and 90-day functional independence (P = 0.076) between trials. Additionally, further analysis on safety outcomes showed no significant difference between embolic agents in SAE at last follow-up (P = 0.78), embolization-related complications (P = 0.087), new onset ischemic stroke (P = 0.98), and deep venous thrombosis (P = 0.94). This meta-analysis of RCTs suggests that while n-BCA is associated with lower all-cause mortality compared to Onyx and Squid in MMAE for cSDH, all three embolic agents demonstrate comparable efficacy and safety.

Introduction : Chronic subdural hematoma (cSDH) is a common neurosurgical condition with a high recurrence rate. Middle meningeal artery (MMA) embolization has been shown to reduce the incidence of re‐bleeding and prevent recurrence of cSDH by devascularizing the subdural membranes and shifting the balance from continued leakage and accumulation of blood and proteinaceous material to reabsorption. We report our single center experience of MMA embolization for treatment of chronic and subacute subdural hematoma. Methods : We performed a retrospective chart review of all patients ≥18 years who underwent MMA embolization between 01/01/2020‐03/01/2021 for cSDH. We looked at the outcomes, rate of recurrence and possible complications after MMA embolization. A descriptive analysis for continuous and categorical variables was performed using SAS 9.4 version. Results : A total of 41 MMA embolizations were performed on 32 patients with a median age of 75 (Q1‐Q3 70–83). Median hematoma thickness was 12 mm. Among them, 52% patients underwent particle embolization while 48% underwent liquid embolization. One patient had recurrence on follow up imaging and required drainage with burr hole. Three patients underwent hematoma evacuation after MMA embolization without evidence of recurrence on imaging. Three cases were aborted due to high risk or difficult access. There were no procedure related complications in the whole study population. 65% patient achieved mRS 0–2 on 90 day follow up visit. There was no significant difference between particles and liquid embolizations. Conclusions : Middle meningeal artery embolization could be used as a safe and effective intervention for prevention of recurrence and improving outcomes of subacute or chronic subdural hematoma.

Middle meningeal artery (MMA) embolization has recently emerged as a potential treatment for chronic subdural hematoma (cSDH). Numerous retrospective studies have suggested that it can potentially reduce the risk of hematoma recurrence following surgical evacuation. We have conducted a randomized controlled trial to investigate the effectiveness of postoperative MMA embolization in reducing recurrence rate, residual hematoma thickness as well as improving functional outcome. Patients aged 18 or above were recruited. Following evacuation through burr hole or craniotomy, patients were randomly allocated to undergo either MMA embolization or standard care (monitoring). The primary outcome was symptomatic recurrence requiring redo evacuation. Secondary outcomes include residual hematoma thickness and modified Rankin Scale (mRS) at 6 weeks and 3 months. Thirty-six patients (41 cSDHs) were recruited between April 2021 and September 2022. Seventeen patients (19 cSDHs) were allocated to the embolization group and 19 patients (22 cSDHs) were in the control group. No symptomatic recurrence was observed in the treatment group while 3 control patients (15.8%) underwent repeat surgery for symptomatic recurrence, however, it was not statistically significant (P = 0.234). Furthermore, there was no significant difference in residual hematoma thickness at 6 weeks or 3 months between the two groups. All patients in the embolization group had a good functional outcome (mRS 0-1) at 3 months, which was significantly higher than the 53% observed in the control group. No complications related to MMA embolization were reported. Further study with larger sample size is required to evaluate the efficacy of MMA embolization.

To the Editor: We thank Lu et al1 for their interest in our article. Middle meningeal artery (MMA) embolization is becoming increasingly used in a subset of pediatric patients, and in the short time since the submission of our manuscript, an additional 2 case reports have been published.2,3 In their letter, Lu et al1 described several important considerations that will guide the selection of appropriate pediatric candidates for MMA embolization. Age—We agree that the age of the patient is an important factor. Among pediatric patients, chronic subdural hematomas are most commonly associated with abusive head trauma, anticoagulation/antiplatelet treatment for congenital cardiac disease, and ventricular shunt overdrainage.4 As a result, pediatric chronic subdural hematomas are often identified in infants and young children. Less common etiologies include neoplastic disease and arachnoid cysts, which can affect pediatric patients of any age. Pediatric patients at the younger end of the spectrum present several unique challenges because of the small caliber of their blood vessels, as well as the importance of limiting iodinated contrast and ionizing radiation.5 Despite these challenges, MMA embolization in young patients is feasible and can be a safe option in select patients when performed by experienced providers. Five of the 8 cases that have been described in the literature involved patients who were 2 years of age or younger.2,3,6-8 Etiology—As highlighted by Lu et al,1 2 patients in our systematic review underwent MMA embolization in the setting of a ruptured arachnoid cyst.9,10 We fully agree that subdural hygromas associated with arachnoid cysts can be treated nonsurgically11 and that even a certain subset of subdural hematomas can also be observed in this setting. As such, we agree that MMA embolization may not be the optimal first-line treatment in such cases. Indeed, both patients described in the literature only underwent MMA embolization after first undergoing either burr hole drainage or subdural-to-peritoneal shunt placement, with subsequent symptomatic recurrence of the hematoma.9,10 Timing—As alluded to above, the timing of intervention is controversial. Only 2 of the patients described in the literature underwent MMA embolization as a first-line treatment.7,12 Given the small number of cases that have been reported to date, we agree that MMA embolization is far from becoming the standard of care among pediatric patients with chronic subdural hematomas. Nevertheless, it represents yet another treatment option in the neurosurgeon's armamentarium and warrants additional study to determine its optimal role. We thank Lu et al1 for pointing out these important considerations and look forward to seeing the pediatric neurosurgical community continue to study the indications, efficacy, and risks of pediatric MMA embolization.

To the Editor: Subdural hematoma is one of the most diagnosed neurosurgical conditions in adults with an incidence rate reported to be 13.4 per 100 000 persons per year.1,2 Although mortality rates have decreased over the past several decades due to progressive advancements in diagnostics, novel treatment strategies are required to better manage patient outcomes.3 Middle meningeal artery (MMA) embolization is one such strategy that has recently emerged to reduce postoperative recurrence. This minimally invasive technique devascularizes the subdural membranes to prevent further bleeding and has proven viable and safe, especially among nonsurgical candidates.4 Here, we investigate the trends in the rates of middle meningeal artery embolization and mortality in patients with subdural hematoma. We queried the National Inpatient Sample database from 2016 to 2020 for patients with principal diagnosis of nontraumatic subdural hematoma (SDH) using the International Classification of Disease 10th Edition (ICD10) code I62. Cases at large urban teaching hospitals were selected. The yearly rate of inpatient mortality and MMA embolization was extracted. Trends in severity, as measured using variables suggestive of clinical severity (mechanical ventilation, hydrocephalus, treatment of hydrocephalus, coma, stupor, cranial nerve palsy, paralysis/paraparesis, and aphasia), were also explored. Multivariate regression analysis was performed to analyze the association between MMA embolization and mortality when controlling for age, socioeconomic status, race, and severity. All statistical analyses were performed using Statistical Product and Service Solutions (SPSS) Statistical Software, and significance was set to P < .05 (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, version 28.0., IBM Corp). All data and ICD10 codes used in this study are available on reasonable request of the corresponding author. There were 173 165 patients with a principal diagnosis of SDH at large urban teaching hospitals from 2016 to 2020. We report an overall decrease in the mortality rate in 2020 (10.5%) as compared with 2016 (10.9%) (Figure 1). The mortality rate in 2016 and 2017 averaged 11.0%, whereas the mortality rate from 2018 to 2020 averaged 10.4%. On the other hand, severity trended upward throughout the years (Figure 2). The yearly rate of craniotomy and burr hole increased slightly from 1.18% to 1.46% and 8.36% to 9.12%, respectively. Notably, the rate of MMA embolization increased more than 10-fold from 2016 (0.2%) to 2020 (2.8%) (Figure 3). Most notable increase was post-2018, depicting its recent importance and success for managing subdural hematoma. Finally, when controlling for severity and demographics, MMA embolization was found to become protective against mortality in 2020, validating the trends stated above (Figure 4).Figure 1.: Yearly trends in mortality rate.Figure 2.: Yearly trends in severity.Figure 3.: Yearly trends in the rate of MMA embolization. MMA, middle meningeal artery.Figure 4.: Relationship between MMA embolization and mortality. MMA, middle meningeal artery.Surgical evacuation through craniotomy is one of the conventional treatments for chronic subdural hematoma. However, studies cite a 30-day mortality rate of 16.5% to 18% and high rates of adverse outcomes, including prolonged mechanical ventilation, return to the operating room, and prolonged length of stay, following craniotomy for subdural hematoma evacuation.3,5 Owing to a high rate of recurrence and perioperative complications associated with open surgery, MMA embolization is emerging to be not only an adjunct but also a stand-alone treatment option for chronic subdural hematoma.6,7 In a prospective study, Ban et al7 reported MMA embolization to be a superior option than conventional treatment options. In this same study, treatment failure for MMA embolization was reported to be only 1.4% as compared with 27.5% among patients who underwent surgical drainage. As we await the results of ongoing clinical trials, our analysis supports these findings and shows an overall inverse trend among the rate of MMA embolization and mortality throughout the United States, even when controlling for severity.

Background: Middle meningeal artery (MMA) embolization has been increasingly applied in adult populations for the treatment of chronic subdural hematomas (cSDH). There is a paucity of literature on the indications, safety, and outcomes of MMA embolization in the pediatric population. Summary: A systematic literature review on pediatric patients undergoing MMA embolization was performed. We also report the case of successful bilateral MMA embolization for persistent subdural hematomas following resection of a juvenile pilocytic astrocytoma. Persistent bilateral subdural hematomas following resection of a large brain tumor resolved following MMA embolization in a 13-year-old male. Indications for MMA embolization in the pediatric literature included cSDH (6/13, 46.2%), treatment or preoperative embolization of arteriovenous fistula or arteriovenous malformation (3/13, 23.1%), preoperative embolization for tumor resection (1/13, 7.7%), or treatment of acute epidural hematoma (1/13, 7.7%). Embolic agents included microspheres or microparticles (2/13, 15.4%), Onyx (3/13, 23.1%), NBCA (3/13, 23.1%), or coils (4/13, 30.8%). Key Messages: Whereas MMA embolization has primarily been applied in the adult population for subdural hematoma in the setting of cardiac disease and anticoagulant use, we present a novel application of MMA embolization in the management of persistent subdural hematoma following resection of a large space-occupying lesion. A systematic review of MMA embolization in pediatric patients currently shows efficacy; a multi-institutional study is warranted to further refine indications, timing, and safety of the procedure.

Chronic subdural hematoma (cSDH) is a common intracranial hemorrhagic disorder with a high incidence rate among the elderly. While small, asymptomatic cSDH may resolve spontaneously, surgical intervention has been the treatment of choice for larger, symptomatic cases. Surgical evacuation of cSDH may be associated with high rates of recurrence, and even asymptomatic cSDH cases tend to progress. Over the last few years, middle meningeal artery (MMA) embolization has proven to be a safe non-invasive treatment of choice with favorable outcomes and a low recurrence rate. The ensuing paper discusses current treatment modalities for cSDH and reviews existing literature on the anatomy of MMA and its embolization as a treatment option for cSDH. Recent studies show that traumatic head injury leading to subdural hemorrhage can induce neovascularization that may initiate a cycle of recurrent subdural hematoma. Distal branches of MMA supply blood to the dural layers. Several studies have revealed that embolization of the MMA can stop the neovascularization process and blood flow. In addition, patients who underwent MMA embolization had a significantly quicker brain re-expansion and lower recurrence rate. Although the management of cSDH is still very much a dilemma, recent research findings bring MMA embolization to light as a promising treatment alternative and adjunctive therapy.

Middle Meningeal Artery Embolization for Membranous Versus Nonmembranous Subdural Hematomas: A Retrospective and Multicenter Cohort Study

Middle meningeal artery (MMA) embolization has been proposed as a minimally invasive treatment for chronic subdural hematoma (cSDH). The aim of this systematic review and meta-analysis is to compare outcomes...