Neurointervention · IR Playbook

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma (MMAE)

Middle meningeal artery embolization devascularizes the vascularized outer membrane of a chronic subdural hematoma, interrupting recurrent microhaemorrhage so that resorption can exceed reaccumulation. The strongest current indication is adjunctive MMAE with surgical drainage to reduce recurrence; stand-alone treatment is reserved for selected neurologically stable patients in whom surgery is high risk or contraindicated because its decompressive effect is not immediate. In EMBOLISE, adjunctive MMAE reduced 90-day recurrence or progression requiring reoperation from 11.3% to 4.1%, while serious embolization-related events occurred in 2.0%. Benefit is not uniform across techniques: particle-based EMPROTECT showed a nonsignificant reduction in 6-month recurrence from 21.0% to 14.8%.

What this playbook covers

• Indications
• Contraindications
• Pre-procedure
• Anatomy and Planning
• Equipment
• Procedure Steps
• Technical Endpoints
• Variants
• Comparisons
• Troubleshooting
• Complications
• Post-procedure Care
• References

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