introduction
chronic subdural hematoma (CSDH) has Significant patient morbidity and recurrence that drives the management towards less invasive procedures. we describe the different indications of middle meningeal artery embolization (MME) in the management of CSDH.
objective
To describe our institutional experience using MME in the management of CSDH.
Methods
Retrospective analysis was conducted between the years 2020 and 2023. We reviewed the different indications MME using different embolization materials. Clinical and radiological outcomes were described 6 months and 1 year postoperatively.
Results
Twenty-one CSDHs were treated in 16 patients (5 patients had bilateral C SDH). In patients with bilateral CSDH, each hematoma was considered separately. Of the 21 hematomas, 7 (33.3 %) were treated upfront without prior surgical treatment, 4 (19.1%) were treated for recurrence after prior surgical evacuation and 10 (47.6%) were treated prophylactically following surgical evacuation. Post embolization, one hematoma needed to be evacuated due to failure of hematoma volume reduction. By the end of one-year follow-up, 50 % reduction in hematoma size was achieved in 13 hematomas (62%), while total disappearance was evident in 7 hematomas (33.3%). Recurrence was noted in one patient on renal dialysis which was managed conservatively. The modified Rankin scale (MRS) was improved after 6 months in comparison to the admission time from 3 ± 1.2 to 1.6 ± 0.63 with p p-value of 0.003.

Conclusion
MME is safe and effective technique that should be considered in the management of CSDH in patients with multiple morbidities and have a high risk of recurrence.