Chronic subdural hematoma (CSDH) is becoming increasingly common in the aging population, and preventing its recurrence after standard surgical drainage remains a significant clinical challenge. Middle meningeal artery embolization (MMAE) has emerged as a promising therapeutic option to interrupt the supply of neovessels to the outer membrane, thereby halting the cycle of inflammation and rebleeding. This review summarizes the latest findings on the therapeutic outcomes of MMAE, with a particular focus on 3 major randomized controlled trials reported in 2024: the STEM, EMBOLISE, and MAGIC-MT trials. Although these studies collectively suggest that MMAE can reduce the risk of treatment failure and recurrence, the results vary in terms of efficacy across different patient populations and study designs. The EMBOLISE trial demonstrated a significant reduction in recurrence requiring reoperation, whereas other trials adopted broader outcome definitions, which may partly explain the heterogeneity in reported efficacy. Consequently, MMAE may not be suitable for universal adoption across all patient populations. The procedure has a favorable safety profile and a low complication rate. Technical factors influencing success include the use of liquid embolic agents for distal penetration and the potential benefits of the transradial approach in reducing postoperative delirium in older patients. In conclusion, although MMAE is a valuable addition to CSDH management, a comprehensive evaluation is essential to optimize clinical outcomes.
Shunsuke Tanoue (Thu,) studied this question.