Middle Meningeal Artery Embolization for Recurrent Chronic Subdural Hematoma.

OBJECTIVE

Repeating surgical treatment remains the main option for recurrent chronic subdural hematoma, but a second recurrence frequently occurs. We employed middle meningeal artery embolization as an alternative treatment for recurrent hematoma. This study aimed to evaluate the effect and safety of middle meningeal artery embolization compared with conventional retreatment.

METHODS

We retrospectively reviewed 1162 patients who underwent management for chronic subdural hematoma between May 1998 and March 2025 and included 142 patients with recurrent hematoma (middle meningeal artery embolization in 46 and conventional retreatment in 96) in this study. The primary outcome was second recurrence, defined as a composite of imaging (recurrent or residual hematoma >10 mm in thickness) and clinical (development or aggravation of symptoms, or second re-operation) events. Secondary outcomes included complications (any adverse events or death) and neurological recovery (return of the modified Rankin scale score to the level before initial hematoma development). Outcomes during treatment and 6-month follow-up were compared between the two study groups using logistic regression analysis, adjusted for variables showing baseline group differences with a p-value <0.2.

RESULTS

The second recurrence rate was significantly lower in patients receiving middle meningeal artery embolization than in those receiving conventional retreatment (1/46 [2.2%] vs. 32/96 [33.3%]; adjusted odds ratio [OR], 0.056; 95% confidence interval [CI], 0.003-0.164; P=0.001). Complication rates did not differ significantly (1/46 [2.2%] vs. 10/96 [10.4%]; adjusted OR, 0.203; 95% CI, 0.019-1.221; P=0.103), but neurological recovery was more frequent in patients receiving middle meningeal artery embolization (32/46 [69.6%] vs. 46/96 [47.9%]; adjusted OR, 3.147; 95% CI, 1.198-8.268; P=0.020).

CONCLUSION

Middle meningeal artery embolization for recurrent chronic subdural hematoma prevented second recurrence and improved neurological recovery compared with conventional retreatment, without increasing the complication rate. These findings suggest that middle meningeal artery embolization could be considered an effective and safe retreatment option for recurrent chronic subdural hematoma.