Middle Meningeal Artery Embolization (Chronic Subdural)
Middle meningeal artery (MMA) embolization is an endovascular procedure that occludes the small dural vessels thought to feed a chronic subdural hematoma. It aims to reduce refilling and recurrence of the hematoma and may be performed alone or in addition to surgical drainage.
Última actualización: 2026-06-09
Definition
MMA embolization is a procedure in which the middle meningeal artery, which supplies the dura, is occluded endovascularly. In chronic subdural hematomas, the membranes surrounding the hematoma are thought to be supplied by fragile, leaky vessels arising from this artery; cutting off that source may help the hematoma shrink over time and stop refilling. The procedure is performed via the groin artery with a microcatheter, occluding the vessel with a liquid embolic agent or small particles. The evidence base is evolving, and the method is currently recommended by some health authorities in selected settings.
Indications
MMA embolization may be considered in patients with chronic subdural hematoma, particularly in those at high risk of recurrence after surgery or with recurrent collections, and in some cases as an alternative to surgical drainage. In patients with mild to moderate symptoms and no significant compressive signs, it may be evaluated as a standalone option. The decision is made by considering the hematoma size and mass effect, the patient's neurological status, use of blood-thinning medication, and overall health together. In the United Kingdom, NICE has addressed this procedure (IPG779) as one that may be used under specific arrangements.
Procedure
The procedure is usually performed in an angiography suite under sedation or general anesthesia. A sheath is placed in the groin (femoral) artery and a catheter is advanced through the external carotid artery into the middle meningeal artery. Angiography is used to assess the vascular anatomy and dangerous anastomoses (for example, connections with the ophthalmic artery). Once the microcatheter is in a safe position, the artery and its branches are occluded using a liquid embolic agent, particles, or coils. After adequate occlusion is confirmed by control angiography, the catheters are withdrawn and the access site is closed.
Advantages and Limitations
MMA embolization is a minimally invasive option performed without opening the skull that aims to reduce the recurrence rate in chronic subdural hematoma; in suitable patients it may offer an adjunct to surgery or an alternative. However, its effect is not immediate but appears as the hematoma slowly regresses over weeks, so it may not be suitable on its own in emergencies with marked compression and rapid deterioration. The level of evidence is evolving and long-term outcomes are still being studied; it requires an experienced interventional neuroradiology team.
Recovery and Risks
After the procedure many patients recover quickly; regression of the hematoma is usually followed with imaging and may take weeks. Possible risks include unintended migration of the embolic agent into other vessels with resulting stroke or visual effects, transient pain in the face or head region, bleeding at the access site, and failure of the hematoma to regress or its enlargement. Some patients may still require surgical drainage. No outcome is guaranteed; the decision is individualized by considering the patient's clinical status, imaging findings, and expectations together.
Referencias
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1080-1084.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011.
- NICE Interventional Procedures Guidance IPG779 — Middle meningeal artery embolisation for chronic subdural haematoma. 2024.
- Link TW, et al. Middle meningeal artery embolization for chronic subdural hematoma. Neurosurgery. 2019.
Este artículo es informativo y no sustituye un examen médico. Las decisiones de diagnóstico y tratamiento son individuales.