Extensive Roles and Technical Advances of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Chronic subdural hematoma (CSDH) is a common pathology that typically affects the elderly in Japan, an aging society. Burr-hole irrigation is the standard treatment, but middle meningeal artery (MMA) embolization is a minimally invasive alternative. MMA embolization for CSDH has frequently been re-ported in recent years, and many technical innovations to improve clinical outcomes have been de-scribed. Embolic materials reaching more distally are found to avoid recurrences after MMA emboliza-tion. As a result, various studies have described the superiority of embolizing the anterior and poste-rior branches of the MMA, the advantages of embolic materials reaching beyond the midline, and a high degree of distal penetration using a sugar rush technique in which 5% soluble glucose is in-jected through an intermediate catheter during MMA embolization. Radiographically, reports have de-scribed the importance of a bright falx sign obtained by infiltrating embolic material beyond the midline and post-embolization enhancement of the dura, capsular membrane, septations, and sub-dural hematoma fluid as indicators of the spread of embolic materials. This review provides an over-view of the current status and future challenges in MMA embolization for CSDH, focusing on technical aspects to improve clinical outcomes.

Automated summary

Chronic subdural hematoma (CSDH), commonly found in the elderly population of Japan, can be treated with either burr-hole irrigation or middle meningeal artery (MMA) embolization. Recent studies have shown the benefits of embolizing both the anterior and posterior branches of the MMA to prevent recurrence. Technical innovations such as the sugar rush technique, which involves injecting soluble glucose during MMA embolization, have also been explored. Radiographically, the spread of embolic materials can be indicated by the bright falx sign and post-embolization enhancement of dural structures and subdural hematoma fluid. This review provides an overview of the current status and future challenges in MMA embolization for CSDH, focusing on technical aspects to improve clinical outcomes.