Case Report: Immediate preprocedural CT as a decision-making checkpoint before middle meningeal artery embolization for traumatic epidural hematoma.

BACKGROUND: Traumatic epidural hematoma (EDH) is typically managed surgically when associated with neurological deterioration or significant mass effect. In neurologically intact patients, conservative management or minimally invasive approaches such as middle meningeal artery (MMA) embolization may be considered. The role of periprocedural imaging in guiding endovascular decision-making remains to be clarified.

CASE PRESENTATION: A neurologically intact patient with a left-sided traumatic EDH underwent planned MMA embolization. Immediate preprocedural noncontrast computed tomography (CT) was not performed prior to angiography. Embolization of the left MMA was successfully completed. Postprocedural CT revealed a newly developed contralateral parietal EDH. Repeat angiography confirmed dural arterial supply from the right MMA, and contralateral embolization was performed during the same session. The patient remained clinically stable and did not require surgical evacuation. Follow-up imaging demonstrated stabilization and gradual resolution of both hematomas.

CONCLUSION: We hypothesize that immediate preprocedural CT may aid decision-making for MMA embolization in selected EDH cases, though this single observation requires validation and is not practice-guiding.