A232 Middle meningeal artery embolization as a minimally invasive strategy for subdural hematoma: early results from an integrated neurovascular program

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Background/Introduction Chronic subdural hematoma (cSDH) carries recurrence rates of 10–30% after burr-hole evacuation. Middle meningeal artery embolization (MMAE) targets the vascularized neomembranes implicated in recurrence and has emerged as a minimally invasive therapeutic strategy. We report early outcomes from an integrated neurovascular program. Objective/Purpose By applying a conservative analytic framework, this study aims to provide a rigorous and reproducible assessment of MMAE performance in contemporary clinical practice. Methods/Case Description We performed a retrospective cohort study of consecutive adults undergoing MMA embolization for subdural hematoma at a tertiary neurosciences center. MMAE was used as primary therapy or adjunct to surgery. Demographic, clinical, radiological, procedural, and outcome data were analyzed. The primary outcome was hematoma recurrence. Secondary outcomes included recurrence requiring surgery, repeat embolization, in-hospital mortality, and discharge modified Rankin Scale (mRS). Results/Findings Fourteen patients (mean age 71.3 years; 64.3% female) underwent MMAE. Midline shift was present in 64.3%, bilateral hematomas in 28.6%, and 50.0% had recurrent disease at presentation. Technical success was achieved in all cases without procedural complications or mortality. Any recurrence occurred in 35.7%, while only 7.1% required surgical evacuation. No patient required repeat embolization, and 92.9% avoided surgical reintervention. Recurrence was associated with midline shift (p=0.021) and bilateral hematoma (p=0.004). Discussion/Conclusions/Learning Points MMA embolization demonstrated excellent safety and low clinically significant failure, supporting its role as a minimally invasive strategy in contemporary subdural hematoma management.

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