Middle Meningeal Artery Embolization with Embospheres for the Treatment of Chronic Subdural Hematomas
Charalampos Christoforou1, Steffen Reißberg2, Tillman Schrammel T1, Marius Konstantin Hartmann2,3,4*
1Neurochirurgie, HELIOS Klinikum Berlin-Buch GmbH, Berlin, Germany.
2Institut für Neuroradiologie, HELIOS Klinikum Berlin-Buch GmbH, Berlin, Germany.
3Institut für Radiologie, Neuroradiologie und Nuklearmedizin, Klinikum Darmstadt GmbH, Darmstadt, Germany.
4University Heidelberg Medical School, Heidelberg, Germany.
*Corresponding Author: Marius Konstantin Hartmann, University Heidelberg Medical School, Heidelberg, Germany.
DOI: https://doi.org/10.58624/SVOANE.2026.07.026
Received: June 12, 2026
Published: August 05, 2026
Citation: Christoforou C, Reißberg S, Schrammel T, Hartmann M. Middle Meningeal Artery Embolization with Embospheres for the Treatment of Chronic Subdural Hematomas. SVOA Neurology 2026, 7:4, 174-183. doi.org/10.58624/SVOANE.2026.07.026
Abstract
Background: Chronic subdural hematomas (cSDH) represent a common neurosurgical pathology with an incidence of 1.7-20.6 per 100,000 persons per year. Surgical evacuation shows a significant recurrence rate with the need of re-evacuation up to 10-20%. Middle meningeal artery embolization (MMAE) is an increasingly common procedure involved in the treatment of chronic subdural hematoma (cSDH) that can be an adjuvant intervention or an alternative to traditional medical or surgical therapies.
Objective: This case series aims to evaluate the effectiveness and safety of the endovascular embolization of the middle meningeal artery with Embosphere® Microspheres for the treatment of cSDHs.
Methods: From 06/2019 to 08/2020 a total of 26 consecutive patients (19 m / 7f; median age 79 (71-85)) with 35 cSDHs (9 bilateral) were treated with MMA embolization. Patients underwent embolization as stand-alone treatment or as adjunct to surgical evacuation either prior to or after surgery. Patients were assessed clinically and with cCT 2, 6 weeks and 3 months after the procedure. Primary outcome was absence of significant recurrence with need for surgery. Complete hematoma resolution or significant reduction of more than 50% of its initial size, periprocedural complications and clinical outcome after the modified Rankin Scale (mRS) were secondary outcome parameters.
Results: MMA embolization was successfully performed in all patients with no serious adverse events. 1 Patient (3.8%) presented a hematoma at the inguinal puncture site without need for further treatment. 13 hematomas received MMAE without surgery, 18 for recurrence after surgical evacuation and 4 in combination with surgical evacuation. From 21/26 patients (80.7%) with 28 cSDHs (80%) follow-up was available for analysis with a median follow-up of 12 weeks (12-15). During follow-up one patient died due to an unrelated cause. From the 28 sufficiently evaluated cSDHs 2 (7.1%) needed surgery for recurrent cSDH after embolization whereas 26 (92.9%) met the primary outcome with 21 (75%) having a complete resolution. The median mRS on admission was 3 (2-4) with mRS at the last follow-up being 1 (0-1).
Conclusion: Data showed that endovascular embolization of the middle meningeal artery with Embosphere® Microspheres is an effective and safe treatment method for patients with chronic subdural hematoma as a stand-alone procedure or in combination with surgery.
Keywords: Chronic Subdural Hematoma, Middle Meningeal Artery, Embolization, Embolic Agents
