Middle Meningeal Artery Embolization and Nonacute Subdural Hematoma

Nonacute subdural hematoma (SDH) is a growing concern among aging populations, particularly with increased use of antiplatelet and anticoagulant therapies. Traditional treatments, including glucocorticoids, statins, and surgical evacuation, are associated with high recurrence rates (15%). Middle meningeal artery (MMA) embolization has emerged as a promising adjunct or standalone therapy to reduce recurrence by targeting the vascularized hematoma membrane. Recent randomized trials (EMBOLISE, MAGIC-MT, STEM) demonstrate its efficacy, with recurrence rates dropping to 5–10% when combined with surgery. However, outcomes vary based on timing (pre- vs. post-surgical embolization) and patient selection (e.g., coagulopathy or nonsurgical candidates). While MMA embolization shows potential, questions remain about its role as primary therapy, optimal embolic materials, and safety in special populations. Further trials are needed to refine its use in SDH management.

Nonacute subdural hematoma (SDH) is a growing concern among aging populations, particularly with increased use of antiplatelet and anticoagulant therapies. Traditional treatments, including glucocorticoids, statins, and surgical evacuation, are associated with high recurrence rates (15%). Middle meningeal artery (MMA) embolization has emerged as a promising adjunct or standalone therapy to reduce recurrence by targeting the vascularized hematoma membrane. Recent randomized trials (EMBOLISE, MAGIC-MT, STEM) demonstrate its efficacy, with recurrence rates dropping to 5–10% when combined with surgery. However, outcomes vary based on timing (pre- vs. post-surgical embolization) and patient selection (e.g., coagulopathy or nonsurgical candidates). While MMA embolization shows potential, questions remain about its role as primary therapy, optimal embolic materials, and safety in special populations. Further trials are needed to refine its use in SDH management.