Volume 30, Issue 175, September 2026

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: Understanding Procedural Risks and Complications

Justyna Kowalczewska^1♦

¹Department of Neurosurgery, University Clinical Hospital in Poznan, Poznan University of Medical Sciences, Poznan, Poland

^♦Corresponding author
Justyna Kowalczewska, Department of Neurosurgery, University Clinical Hospital in Poznan, Poznan University of Medical Sciences, Poznan, Poland

ABSTRACT

Chronic subdural hematoma (cSDH) is frequently diagnosed in older patients, and the incidence continues to increase as the population ages, antithrombotic therapy becomes more common, and diagnostic imaging is more widely available. Recurrence after surgical treatment remains an important clinical issue. Middle meningeal artery embolization (MMAE) is a minimally invasive treatment that reduces cSDH recurrence by interrupting the vascular supply to the hematoma membrane. However, increasing use of MMAE requires careful consideration of its procedure-related risks. This narrative review summarizes current evidence regarding the safety and complications of MMAE for cSDH. Recent findings indicate that MMAE has a generally promising safety profile. Although sporadic serious complications may occur. The most clinically important adverse events include ischemic stroke, intracranial hemorrhage, visual impairment, facial nerve palsy, vascular injury, and access-site complications. Non-target embolization through ophthalmic, intracranial, or cranial nerve vascular anastomoses represents an important mechanism of neurological complications. Four recent randomized controlled trials—EMBOLISE, MAGIC-MT, STEM and EMPROTECT—did not demonstrate a substantial increase in overall serious adverse events associated with MMAE. However, rare procedure-related ischemic events were reported. Careful angiographic identification of dangerous collateral pathways, appropriate distal microcatheter positioning and controlled embolic agents delivery are essential measures for reducing procedural risk. MMAE appears to be a relatively safe treatment option for appropriately selected patients with cSDH. Standardized reporting of adverse events and further prospective studies are recommended to better characterize the safety profile of MMAE.

Keywords: chronic subdural hematoma (cSDH), middle meningeal artery embolization (MMAE), complications, endovascular treatment, recurrence of cSDH

Medical Science, 2026, 30, e185ms3973

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DOI: https://doi.org/10.54905/disssi.v30i175.e185ms3973

Published: 12 September 2026