Radiographic and Angiographic Predictors of Response after Middle Meningeal Artery Embolization for Chronic Subdural Hematoma
DOI:
https://doi.org/10.37287/ijghr.v8i6.2724Keywords:
angiographic predictors, chronic subdural hematoma, middle meningeal artery embolization, radiographic predictors, treatment responseAbstract
Middle meningeal artery embolization (MMAE) is a minimally invasive treatment for chronic subdural hematoma (cSDH), yet predictors of treatment response remain incompletely defined. To evaluate radiographic, angiographic, and procedural predictors of treatment response after MMAE in adults with cSDH. The literature search, covering January 2000 to June 2026, identified 582 records from PubMed, the Cochrane Library, and ScienceDirect. After screening and eligibility assessment, 11 studies were included in the narrative synthesis. Septated, laminar, and trabecular hematomas were associated with better or faster response, whereas homogeneous or separated architecture, residual thickness, mixed density, and greater midline shift were associated with delayed resolution or failure. Small MMA diameter and limited distal embolic penetration were linked to poorer outcomes, while greater embolic volume favored radiographic resolution. Embolizing additional branches or selectively targeting the dominant branch did not consistently improve outcomes. MMAE response depends on hematoma biology, vascular anatomy, and embolic distribution rather than a single imaging variable, offering a framework that may help guide risk stratification, patient selection, and follow-up planning in research on MMAE.
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