Middle Meningeal Artery Embolization for Chronic Subdural Hematoma Using 100–300 Microns Embosphere®: A Technical Overview and Review of Key Concepts

Background— Endovascular embolization of the middle meningeal artery (MMA) has emerged as an excellent
alternative to conventional surgery for treating chronic subdural hematoma (cSDH). Previously published case
reports/series have mostly used polyvinyl alcohol particles, N-butyl-2-cyanoacrylate (NBCA), gelatin sponge,
coils, or onyx for MMA embolization. We successfully performed 20 MMA embolization procedures using 100-300
microns Embosphere® microspheres from April 2019 to September 2019.
Methods— All the consecutive MMA embolization procedures performed at our institution from April 2019 to
September 2019 were reviewed. Images were selected from MMA embolization procedures in order to illustrate the
technique.
Results— We describe in detail our technique of MMA embolization using 100-300 μm Embosphere® microspheres for treating cSDH along with pearls and pitfalls to look out for to avoid complications. We provide
angiogram images demonstrating the MMA anatomy, potential dangerous anastomosis, contrast enhancement pattern
of the subdural membranes during angiography and post-procedure CT head findings.
Conclusion— MMA embolization with 100-300 μm Embosphere® microspheres for treating cSDH is technically
feasible and safe.