Related Experiment Video
Updated: Jan 6, 2026
Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage
Published on: August 30, 2020
Embolization of the Middle meningeal artery in chronic subdural hematoma - A systematic review
Jordan Court1, Charles J Touchette2, Christian Iorio-Morin2
1Department of radiology, Université de Sherbrooke, Québec, Canada.
Insights
Middle meningeal artery embolization (MMAE) is a feasible treatment for chronic subdural hematomas (cSDH). While effective in resolving hematomas, more high-quality evidence is needed before MMAE becomes a standard neurosurgical procedure.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Vascular Surgery
Background:
- Chronic subdural hematomas (cSDH) are a common neurosurgical consultation.
- Middle meningeal artery embolization (MMAE) is being explored as an alternative to surgery for cSDH.
- Current evidence requires evaluation before MMAE integration into clinical practice.
Purpose of the Study:
- To systematically review the literature on MMAE for cSDH.
- To assess the safety, feasibility, indications, and efficacy of MMAE in cSDH patients.
- To evaluate the existing evidence for MMAE in managing cSDH.
Main Methods:
- Systematic literature review following PRISMA guidelines.
- Data extraction from 18 original articles.
- Analysis of data from 190 patients who underwent MMAE.
Main Results:
- MMAE was performed in 190 patients, with 81.3% being symptomatic cSDH.
- Over half (52.3%) of patients were on antithrombotic therapy.
- High resolution rates (96.8%) were reported, with no procedural complications.
- Polyvinyl alcohol (PVA) particles were used in 83% of procedures.
Conclusions:
- MMAE is a feasible technique for treating chronic subdural hematomas.
- The current evidence base is insufficient to recommend MMAE as a standard treatment.
- Further high-level evidence studies are required for formal recommendation of MMAE.
Abstract:
Chronic subdural hematomas (cSDH) are one of the most frequent reasons for consultation in neurosurgery. Multiple authors have proposed middle meningeal artery embolization (MMAE) as an option in cSDH patients to manage recurrence or avoid surgery altogether. Although many articles have been published on the matter, the current body of evidence still has to be evaluated before MMAE is integrated into clinical practice. The goal of this study was to review the evidence on MMAE in cSDH to assess its safety, feasibility, indications and efficacy. We performed a systematic review of the literature according to PRISMA guidelines using multiple electronic databases. Our search yielded a total of 18 original articles from which data were extracted. A total of 190 patients underwent MMAE from which 81.3% were symptomatic cSDH. Over half (52.3%) of the described population were undergoing antithrombotic therapy. Most (83%) procedures used polyvinyl alcohol (PVA) particles and no complications were reported regarding the embolization procedures. Although the definition of resolution varied among authors, cSDH resolution was reported in 96.8% of cases. MMAE is a feasible technique for cSDH, but the current body of evidence does not yet support its use as a standard treatment. Further studies with a higher level of evidence are necessary before MMAE can be formally recommended.
