Ces radiol. 2026, 80(2):71-75 | DOI: 10.55095/CesRadiol2026/016

Embolization of the middle meningeal artery in the treatment of chronic subdural hematoma: results from recent prospective randomized trials and clinical practice implications

David Brustman^{1, 3}, Antonín Krajina^{1, 3}, Tomáš Česák^{2, 3}, Michael Bartoš^{2, 3}, Jaroslav Adamkov², Miroslav Cihlo², Jan Mašek^{1, 3}, Vendelín Chovanec^{1, 3}, Jiří Preis⁴, Jan Raupach^{1, 3}

¹ Radiologická klinika Fakultní nemocnice Hradec Králové

² Neurochirurgická klinika Fakultní nemocnice Hradec Králové

³ Lékařská fakulta Univerzity Karlovy, Hradec Králové

⁴ Neurochirurgické oddělení Nemocnice Pardubického kraje, Pardubice Korespondenční adresa:

Brustman D, Krajina A, Česák T, Bartoš M, Adamkov J, Cihlo M, Mašek J, Chovanec V, Raupach J. Embolization of the middle meningeal artery in the treatment of chronic subdural hematoma: results from recent prospective randomized trials and clinical practice implications



Chronic subdural hematoma is common neurosurgical condition, particularly in elderly patients and in those taking anticoagulant or antiplatelet medications, often requiring neurosurgical treatment. Standard surgical evacuation of the hematoma rapidly removes the subdural collection; however, recurrence occurs in 10-20% of patients in prospective studies, especially in the membranous type of hematoma. Recurrence is driven by chronic inflammatory reactions and the proliferation of fragile neovasculature within immature

membranes, which leads to repeated bleeding into the hematoma.

Selective embolization of the middle meningeal artery (MMAE) interrupts the vascular supply to these pathological membranes, thus providing a causal treatment for cSDH. Prospective multicenter studies show that MMAE significantly reduces the risk of recurrence and treatment failure, while demonstrating good patient tolerability and a low complication rate. The most robust prospective data are available for liquid embolic agents based on ethylene-vinyl alcohol copolymers (EVOH), whereas cyanoacrylate glues and microparticles represent alternative options with comparable clinical outcomes and complication rates. Overall, prospective evidence supports MMAE as an effective adjunct to surgical therapy or, in selected cases, as a standalone treatment, particularly in patients at high risk of recurrence.

Keywords: chronic subdural hematoma, middle meningeal artery embolization, recurrence of chronic subdural hematoma, endovascular treatment, prospective clinical trials.

Accepted: February 24, 2026; Published: July 1, 2026  Show citation