Standalone short-coil embolization of the middle meningeal artery for subdural hematomas: Efficient, safe, and...

Traditional surgical management of chronic and nonacute subdural hematomas (NASDH) is associated with high recurrence and often requires reoperation. Middle meningeal artery (MMA) embolization has emerged as a minimally invasive alternative. Most studies to date have used liquid or particle embolics, which carry risks of non-target embolization and neurologic complications. Coil-only embolization offers controlled, localized occlusion and may represent a safer, simpler option, though existing data are limited by small cohorts and inconsistent techniques.

We performed a retrospective review of all patients who underwent standalone coil MMA embolization for NASDH at our institution from 2022 to 2025. Short coils were deployed in a Y-configuration across anterior and posterior divisions or within the MMA trunk. Coil sizing was guided by the Spinosum Roentgen Index (S.R.I.).

The study included 52 patients who underwent 71 procedures (mean age: 71 years). Embolization was performed upfront in 48 %, prophylactically post-surgery in 44 %, and as salvage in 8 %. Technical success was achieved in 97 %, with no procedural complications. Mean hematoma thickness decreased by 7.8 mm at one month and 13.6 mm at three months (both p < 0.001). Density declined by 12.5 HU and 22.5 HU, respectively (both p < 0.001). The S.R.I. correlated strongly with MMA diameter (p < 0.001) and reliably guided coil sizing. Mean fluoroscopy time was 5.8 min. Larger MMA diameter was associated with greater early density reduction (p = 0.010).

This study represents the largest single-center series of standalone coil embolization for NASDH. The technique demonstrated excellent safety, hematoma resolution, and procedural efficiency.