Embolization of the Middle Meningeal Artery in Chronic Subdural Hematomas.

ABSTRACT: Middle meningeal artery embolization (MMAE) is a relatively new option for treating chronic subdural hematoma (CSDH). First used in the year 2000 in patients with CSDH and pronounced coagulopathy, today there are several large randomized controlled trials available that report on the efficacy of MMAE. Based on a complex pathophysiological model of CSDH with a focus on inflammation, fibrinolysis, and neoangiogenesis, the MMAE procedure works by blocking the pathological vessels of the CSDH membranes, whose activity prevents resorption of a CSDH. Embolization of the middle meningeal artery requires precise knowledge of the individual anatomy, as severe adverse effects can result from misembolization in critical collaterals. In principle, particles, liquid embolic agents, and coils are available as embolic agents, although particles and liquid embolic agents have been used in the randomized controlled trials published so far. Based on the latest large trials, MMAE is currently recommended by interdisciplinary consensus for patients with de novo CSDH and contraindications to surgical therapy, as well as for patients with recurrence as an adjunct to conventional therapy. Numerous other trials on MMAE have already been registered, so additional data regarding previously unanswered questions are expected in the near future.

KEY POINTS: · MMAE is an increasingly important treatment option for CSDH.. · MMAE devascularises pathological haematoma membranes.. · Recent studies show a significant reduction in CSDH recurrences and reoperations following MMAE.. · A thorough understanding of anatomy and careful patient selection are crucial..

CITATION FORMAT: · Michael AE, Behme D, Nikoubashman O etal. Embolization of the Middle Meningeal Artery in Chronic Subdural Hematomas. Rofo 2026; DOI 10.1055/a-2851-9748.