A minimally invasive embolization that treats chronic subdural hematoma at its source — cutting off the abnormal blood supply feeding the collection, without open brain surgery.
A chronic subdural hematoma is a collection of blood that forms on the surface of the brain, underneath its protective covering (the dura). It typically affects people over 60, and is usually the result of minor head trauma, ageing, or blood-thinning medication. As blood accumulates between the brain and skull, it puts pressure on the brain, causing headache (the most common symptom, seen in roughly 80% of patients), memory impairment, weakness, nausea, vomiting, impaired vision, confusion, or seizures. As the hematoma grows, patients can develop varying degrees of paralysis and, in advanced cases, coma. Because of its slow, sometimes vague presentation, chronic SDH can be mistaken for dementia, stroke, a transient ischaemic attack, or a brain tumour.
Considered on its own for suitable patients based on hematoma size, location, and overall health.
After burr hole drainage, to reduce the risk of the hematoma recurring.
For a hematoma that has come back after previous surgery.
A cerebral angiogram maps the network of dural vessels contributing to the hematoma.
A catheter is guided from the groin or wrist artery to the middle meningeal artery.
Embolic material blocks blood flow to the dura, sparing normal circulation to the brain.
Patients are observed overnight; most resume normal activity within a few days.
Depending on its size and the symptoms it causes, chronic SDH has traditionally been managed either surgically — burr hole evacuation, craniotomy, or a subdural drainage port — or conservatively, with medical therapy and serial imaging alone. Neither approach is fully reliable on its own: conservatively managed SDH can progress in up to 34% of cases, and even after successful surgical evacuation, the hematoma recurs in an estimated 10 to 20% of patients, often requiring repeat surgery.
Middle meningeal artery embolization is a minimally invasive, image-guided procedure that treats chronic subdural hematoma by reducing blood flow to the dura — the brain's protective covering. Rather than draining the existing blood collection through an opening in the skull, MMAE targets the underlying cause: it interrupts the abnormal, fragile blood vessels and the ongoing inflammatory process within the dura that keeps feeding the hematoma's growth. With that blood supply reduced, the hematoma's membrane stops being resupplied, and in many patients, the existing collection gradually reduces on its own.
Recent clinical trials have strengthened the case for MMAE considerably. Multiple randomised controlled trials and large single-centre series published in 2024 and 2025 show that adding MMAE to standard care meaningfully reduces the rate of hematoma recurrence and re-treatment compared with standard management alone. This evidence has moved MMAE from an experimental add-on toward a genuine first-line option — particularly for patients at high surgical risk, those on blood thinners, or those with recurrent hematomas after prior surgery.
Mapping the blood vessels — under sedation, a catheter is inserted through the femoral (groin) or radial (wrist) artery and guided to the middle meningeal artery. A cerebral angiogram maps the network of dural vessels contributing to the hematoma.
Embolization — through the same catheter, an embolic material is injected superselectively into the vessels supplying the dura, blocking their blood flow while preserving normal circulation to surrounding brain structures.
Recovery and follow-up — patients are observed overnight. Most go home the following day and resume normal activities within a few days, with follow-up imaging to confirm the hematoma is regressing.
The whole procedure typically takes under an hour.
Suitability depends on several factors assessed individually: the hematoma's size and location, the patient's overall health, and any underlying medical conditions that could affect the procedure. MMAE may be considered as a standalone first-line treatment, as a preventive measure after burr hole drainage to reduce recurrence risk, or to treat a hematoma that has recurred after previous surgery.
Both. MMAE can be a standalone first-line treatment, a preventive add-on after burr hole surgery to cut recurrence risk, or a treatment for a hematoma that's come back after previous surgery.
Recent randomised trials show adding MMAE to standard care significantly reduces recurrence and re-treatment compared with standard management alone — why it's increasingly used as first-line therapy in appropriate patients.
Yes — this is exactly where MMAE is most valuable, since it carries a lower complication risk than open surgery and often suits patients on anticoagulants or those otherwise too high-risk for surgery.
Under sedation, a catheter is guided from the groin or wrist to the middle meningeal artery. An angiogram maps the vessels feeding the hematoma, then embolic material blocks blood flow to them, sparing normal circulation elsewhere. Takes under an hour.
Book a consultation with Dr. Giragani, or send your scans for a specialist second opinion.