Document resource
Introduction Middle meningeal artery (MMA) embolization is increasingly utilized in the treatment of chronic subdural hematomas (cSDH), most commonly as an adjunct to surgical evacuation. Prior studies have demonstrated the benefit of bilateral MMA embolization following unilateral surgical intervention. However, the role of bilateral embolization in patients who have not undergone surgical disruption of the dura remains less well defined.The efficacy of MMA embolization as a standalone therapy, particularly when targeting the contralateral MMA in cases of unilateral cSDH, is not well established. In this study, we present our experience evaluating outcomes of unilateral cSDH treated with contralateral MMA embolization without surgical intervention.Methods An IRB-approved, prospectively maintained database of the senior authors’ cases was retrospectively reviewed to identify patients with unilateral cSDH who underwent bilateral MMA embolization without surgical treatment. Patient demographics, hematoma volume and short- and long-term radiographic imaging were evaluated.Results Over the study period of September 2020 to August 2025, there were 59 patients that met our inclusion criteria. The average age of the patients were 75 ± 1.5 years with 16 being Female (27%). Our cohort was made up of 42 White patients (71%), 12 Hispanic patients (20%), 2 Black patients (3%), and 3 others (5%).Of the cases, the average cSDH thickness was 7.9 ± 0.9 mm with an average midline shift of 2.6 ± 0.4 mm. Short term follow-up CT scans were performed for all patients 4.1 ± 0.6 days following MMA embolization. Of these, 38 patients (67%) showed no change in SDH size, 7 patients (12%) with mild decrease in SDH size, and 2 patients (3.5%) with a slight increase in SDH size.Long term CT follow-up was acquired for 15 patients (26%) 8.7 ± 0.9 months following MMA embolization. No change in SDH size was still seen in 2 patients (13%), while mild and significant decreases in SDH size were seen in 3 and 10 patients (20, 67%), respectively. In this cohort, two patients (3%) progressed to needing surgery for evacuation of their cSDH.Conclusion This study demonstrates that bilateral MMA embolization for unilateral cSDH without surgical evacuation can be an effective standalone treatment. While short-term changes were modest, the majority of patients who underwent extended imaging showed progressive hematoma resolution, suggesting that therapeutic benefits continue to accrue over time. These findings support the role of bilateral MMA embolization as a minimally invasive alternative to surgery in appropriately selected patients with unilateral cSDH.Disclosures J. Campos: 2; C; Rapid Medical. J. Collard de Beaufort: None. K. Van Orden: None. M. Arthur: None. B. Polis: None. J. Hamilton: None. F. Laghari: None. N. Beaty: 6; C; Medtronic Neurovascular, Stryker Neurovascular, CMO of NeuroMedica. G. Colby: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Rapid Medical, Cerenovus, Stryker Neurovascular. A.L. Coon: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Stryker Neurovascular, Cerenovus, Rapid Medical, Avail MedSystems, Imperative Care, Deinde, InNeuroCo, Q’apel. 6; C; MicroVention-Termo, Stryker Neurovascular, Medtronic Neurovascular.