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Original research
Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption
  1. Sam Ng1,
  2. Imad Derraz2,
  3. Julien Boetto1,
  4. Cyril Dargazanli2,
  5. Gaëtan Poulen1,
  6. Gregory Gascou2,
  7. Pierre-Henri Lefevre2,
  8. Nicolas Molinari3,
  9. Nicolas Lonjon1,
  10. Vincent Costalat2
  1. 1 Department of Neurosurgery, Montpellier University Medical Center, Montpellier, Occitanie, France
  2. 2 Department of Neuroradiology, Montpellier University Medical Center, Montpellier, Occitanie, France
  3. 3 Department of Statistics, Montpellier University Medical Center, Montpellier, Occitanie, France
  1. Correspondence to Dr Sam Ng, Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier, France80, France; s-ng{at}


Background Chronic subdural hematoma (CSDH) is a common condition requiring surgical treatment; however, recurrence occurs in 15% of cases at 1 year. Middle meningeal artery (MMA) embolization has recently emerged as a promising treatment to prevent CSDH recurrence.

Objective To investigate the effect of MMA embolization on hematoma volume resorption (HVR) after surgery in symptomatic patients.

Methods From April 2018 to October 2018, participants with CSDH requiring surgery were prospectively randomized in a pilot study, and received either surgical treatment alone (ST group) or surgery and adjuvant MMA embolization (ST+MMAE group). The primary outcome was HVR measured on the 3 month CT scan compared with the immediate pre-embolization CT scan. Secondary outcomes were clinical recurrence of CSDH and safety measures.

Results 46 patients were randomized and 41 of these achieved a 3 month follow-up . Twenty-one patients received MMA embolization. At 3 months, the HVR from postsurgical level was higher in the ST+MMAE group (mean difference 17.5 mL, 95% CI 3.87 to 31.16 mL; p=0.015). Two participants presented a CSDH recurrence (one in each group). One patient died (ST group). No MMA embolization-related adverse events were reported.

Conclusion The addition of MMA embolization to surgery led to an increase in CSDH resorption at 3 months. One recurrence of CSDH was reported in each group, and there were no treatment-related complications.

  • chronic subdural hematoma
  • embolization
  • middle meningeal artery
  • surgery

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  • SN and ID contributed equally.

  • Contributors SN and ID contributed equally to this paper. SN, ID and JB: data collection, analysis and interpretation of the data. NM: statistical analysis. SN: paper writing. NL and VC designed the study and supervised the project. SN, JB, GP, NL: surgical management. ID, CD, GC, PHL, VC: neurointerventional management.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available from the corresponding author upon reasonable request