Middle Meningeal Artery Embolization Using Coils for Subdural Hematoma in Patients with Cancer: Safety and Effectiveness.

PURPOSE: To evaluate the safety and effectiveness of coil-only middle meningeal artery embolization (MMAE) for the treatment of subacute to chronic subdural hematoma (SDH) in patients with cancer.

MATERIALS AND

METHODS

A single-center retrospective analysis was performed of 30 patients with cancer with SDH, 12 of whom had bilateral hematomas, who underwent MMAE of the affected side(s) using coils alone between 2022 and 2025. Clinical and radiographic outcomes were evaluated, including hematoma resolution, change in SDH thickness, need for reoperation, and overall survival.

RESULTS

Median SDH thickness declined from 12 mm (interquartile range [IQR], 9 mm) before embolization to 3.6 mm (IQR, 8.8 mm) on final imaging (Wilcoxon signed-rank z = 4.59, P < .001). A ≥50% reduction was observed in 56% of SDHs, and complete radiographic resolution was observed in 37%. One patient (3%) required surgical evacuation after MMAE. Seventeen patients (59%) died due to cancer progression during follow-up. Median survival was significantly longer among patients with reduced hematoma thickness at initial follow-up imaging (148 vs 29 days, log-rank P = .0002).

CONCLUSIONS

Coil-only MMAE may be a safe and effective treatment option for SDH in patients with cancer. Reduction in hematoma thickness was associated with longer survival in this high-risk population.