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Semin intervent Radiol
DOI: 10.1055/a-2770-6246
Review Article

Chronic Subdural Hematomas in the Era of Middle Meningeal Artery Embolization

Authors

  • Ansaar T. Rai 

    1   Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, One Medical Center Drive, Morgantown, West Virginia
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Abstract

Chronic subdural hematoma (cSDH) is a common, age-associated condition driven largely by ground-level falls and the widespread use of antithrombotic agents. Its burden is rising with aging population, and a substantial subset of patients meet practical criteria for middle meningeal artery embolization (MMAE). Contemporary understanding frames cSDH as a vascular-inflammatory disorder with recurrent microhemorrhage from fragile neovessels, largely supplied by branches of the middle meningeal artery. Standard care has traditionally relied on surgical evacuation, yet recurrence and reintervention remain frequent in high-risk cohorts. Over the last several years, randomized trials have evaluated MMAE as an adjunct or alternative to usual care. Three trials—EMBOLISE, STEM, and MEMBRANE—demonstrated reduced treatment failure or reoperation with adjunctive MMAE. These findings, coupled with rapid real-world adoption of MMAE, support embolization as an effective strategy to lower recurrence, especially when used with indicated surgery. Remaining questions include optimal patient selection, choice of embolic agent, target depth and laterality (distal vs. proximal, unilateral vs. bilateral), anesthesia strategy, and standardized angiographic workflows that mitigate anastomotic risks. Addressing these evidence gaps, along with health-system planning for rising volumes, will refine algorithms and improve outcomes in this growing population.

Keywords

subdural - hematoma - embolization - middle meningeal artery


Publication History

Article published online:
10 February 2026

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