Document resource
Background Middle meningeal artery (MMA) embolization has emerged as an effective treatment for chronic subdural hematoma (cSDH). Liquid embolic agents such as N-butyl cyanoacrylate (NBCA) enable distal penetration of pathologic membranes but are limited by the risk of reflux into hazardous anastomoses and catheter-related complications. We describe the ‘Coil-N-Glue’ technique, a structured, anatomy-based approach designed to facilitate controlled distal NBCA penetration while minimizing reflux using a single microcatheter.Methods We retrospectively reviewed consecutive patients undergoing MMA embolization for cSDH between January and August 2025. A stepwise technique was employed in which shapeless coils were sequentially deployed in high-risk MMA branches—including the petrosquamosal, meningo-lacrimal, and selected frontal branches—followed by distal NBCA embolization (1:4 dilution). Procedural characteristics, embolization patterns, and clinical and radiographic outcomes at 3 months were analyzed.Results Twenty-two patients (31 MMA territories) were treated. Favorable MMA anatomy permitting the full technique was present in 96.7% of cases. A single microcatheter was used in 97% of procedures. Distal NBCA penetration was achieved in 90.3% of embolizations, with no cases of reflux beyond coil-protected segments or microcatheter entrapment. Mean procedural time per side was 8.2 minutes. At 3 months, mean hematoma thickness decreased significantly (18.6 mm to 2.3 mm, p<0.05), and only 1 patient (4.5%) required surgical evacuation. There were no major complications; one minor groin hematoma was managed conservatively.Conclusions The Coil-N-Glue technique is a safe, efficient, and reproducible strategy for MMA embolization that enables controlled distal NBCA penetration while preventing reflux into hazardous branches. This anatomy-based, single-microcatheter approach may improve procedural efficiency and embolization quality in the treatment of cSDH.Disclosures O. Doron: None. I. Awad: None. R. Nalor: None. S. Polster: None. O. Choudhri: None.Abstract E-189 Figure 2Abstract E-189 Figure 1