Determinants of Radiation Exposure in Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Single-Center Cohort Study.

PURPOSE: To identify patient- and procedure-related factors associated with radiation exposure during middle meningeal artery (MMA) embolization for chronic subdural hematoma (cSDH), with particular focus on embolic agent (particle vs. liquid) and arterial access route (transradial vs. transfemoral).

METHODS

In this retrospective single-center cohort study, we included all patients who underwent MMA embolization for cSDH between February 2021 and October 2025. MMA embolization was performed by fourteen experienced board-certified neuroradiologists. The primary outcome was dose area product (DAP, Gy · cm2). Univariable and multivariable linear regression analyses were performed to assess associations between DAP and age, sex, access route, treated side (unilateral vs bilateral), embolic agent, anesthesia, interventionalist, and guiding catheter.

RESULTS

A total of 112 patients (median age 81 years; 20% female) were included; 69 (62%) underwent embolization with particles and 43 (38%) with liquid agents. Transradial access was used in 17 (15%) and transfemoral access in 95 (85%) procedures. Overall median (IQR) DAP was 74.7 Gy · cm2 (55.6-102.4), with 65.5 Gy · cm2 (50.6-82.0) for unilateral and 107.6 Gy · cm2 (84.1-161.6) for bilateral embolization. Univariable analyses showed no significant association between DAP and age, sex, embolic agent, access route, anesthesia, guiding catheter, or interventionalist. In multivariable analysis, unilateral right and left MMA embolization remained independently associated with significantly lower DAP compared with bilateral procedures, while embolic agent and access route were not significantly associated with radiation exposure.

CONCLUSION

In MMA embolization for cSDH, radiation exposure is primarily driven by procedural extent, with higher DAP in bilateral than in unilateral embolization, whereas the choice of embolic material and arterial access route is not associated with radiation dose. These findings support selecting embolic agents and access routes based on anatomical and clinical considerations rather than radiation concerns.