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Materials and Methods We retrospectively reviewed 52 cases (86 sides) of middle meningeal artery (MMA) embolization for chronic subdural hematoma (cSDH) performed at our institution between October 2024 and December 2025. In all cases, under general anesthesia, a 3.2-Fr distal access catheter was placed in the extracranial segment of the MMA, followed by superselective angiography and high-resolution cone-beam CT (CBCT).Results In 41 of 86 sides (47.6%), septal structures within the cSDH were visualized, and in 35 sides (40.6%), contrast enhancement of the dural border cell layer (DBCL) located on the cortical surface side of the hematoma membrane was confirmed. Subsequently, a 1.5-Fr microcatheter was advanced as distally as possible into the frontal and parietal branches of the MMA, and embolization was performed using 12% NBCA.Postoperative CBCT demonstrated glue penetration into the DBCL in 24 cases (27.9%). In cases in which glue permeation into the DBCL was achieved, no recurrence of the hematoma was observed during a mean follow-up period of 7 months. In addition, reduction or complete disappearance of the hematoma without burr-hole surgery after MMA embolization was observed in 34 cases.Conclusions CBCT performed under superselective imaging from the MMA enabled high-resolution visualization of the vascular architecture of cSDH. It also allowed evaluation of the DBCL structure and was useful for assessing the efficacy of MMA embolization. These findings may contribute to a better understanding of the pathophysiology of the DBCL.Disclosures M. Tanaka: None.Abstract E-287 Figure 1