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Introduction Middle meningeal artery (MMA) embolization has become a prominent therapy in the management of chronic subdural hematomas (cSDHs). To date, there has not been a systematic review detailing the concurrent use of pharmacologic agents to selectively target the underlying pathophysiology of cSDHs. We detail a review of the literature for adjuvant medical therapies in conjunction with MMA embolization.Methods A literature search was conducted to identify studies describing the usage of periprocedural medication adjuncts during MMA embolization. Searches were performed using PubMed with the search strategy: (‘Middle Meningeal Artery’ OR MMA OR ‘meningeal artery’) AND (Avastin OR Bevacizumab OR ‘TXA’ OR ‘Tranexamic Acid’ OR ‘medication adjunct’) AND (embolization). These criteria were selected to ensure that articles describe MMA embolization technique, and mention the usage of additional medication.Results A total of 80 articles were identified using the search strategy described. Of these, 57 were removed for irrelevancy, 15 were removed for being the wrong study type, and another four were removed for being duplicates. Four reports described adjunctive medical therapy, however three of these described the independent use of tranexamic acid without embolization. Similarly, one case report described adjunctive bevacizumab injection for cSDH treatment. A single clinical trial detailed the adjunctive use of tranexamic acid with MMA embolization while investigating post-cSDH evacuation outcomes in cohorts given TXA versus embolization alone.Conclusion There remains a paucity of literature for intra-arterial administration of pharmacologic therapies to target neovascularization and expanding cSDHs during embolization of middle meningeal artery treatments. Further studies are needed to address the efficacy and risk profile of adjuvant intra-arterial pharmacologic medical therapies during cSDH treatment.Disclosures J. Collard de Beaufort: None. J. Campos: 2; C; Rapid Medical. B. Polis: None. J. Hamilton: None. K. Van Orden: None. M. Arthur: 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