Perceived Safety and Efficacy of Middle Meningeal Artery Embolization: Results from an International Survey.

BACKGROUND

Middle meningeal artery embolization (MMAE) is a promising new treatment for chronic SDH (cSDH). We conducted an international multi-disciplinary survey among physicians involved in the care of cSDH patients to understand the perceived safety profile and efficacy of MMAE in real-world clinical practice.

METHODS

The survey was distributed via several neurointerventional society mailing lists. We collected data on participant demographics, practice patterns, volumes and experience, perceived MMAE safety, complication tolerance, and decision-making. Data were analyzed using descriptive statistics, non-parametric tests and multi-variable regression.

RESULTS

Five-hundred-seventy-seven physicians completed the survey between November 20th, 2024 and May 1st, 2025 (median age 42.0 years, 489 [84.7%] male, comprised of endovascular neurosurgeons [185/577, 32.1%], interventional neuroradiologists [181/577, 31.4%]). The recent positive MMAE trials led to cSDH management, particularly in among endovascular neurosurgeons (adjusted odds ratio 2.56 [95% CI 1.51-4.35] compared to interventional neuroradioligists [reference]), and less so among other specialties. There were region-specific differences in rates of practice change and a negative association of physician age and practice change (adjusted odds ratio 0.72 [95% CI 0.53-0.99]). Most participants would now consider MMAE in patients with a new cSDH diagnosis with high perceived recurrence risk (192/424 [45.3%]), while 101/424 (23.8%) would consider MMAE for all cSDH patients. The highest acceptable risk for major complications was 4.0% (median, IQR, 2-5%), although this differed between regions and specialties.

CONCLUSION

Recent trials on MMAE for cSDH treatment have changed practice patterns of cSDH management globally. MMAE is now considered a viable option by most physicians even for patients with first-time cSDH. Most would tolerate a maximum of 4% major complications, although rates of practice change and acceptable risk thresholds vary by region and specialty.