Middle meningeal artery embolisation in chronic subdural hematoma: A double-edged sword

doi:10.12998/wjcc.v13.i28.109364

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Oct 6, 2025 (publication date) through Feb 14, 2026

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World Journal of Clinical Cases

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2307-8960

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Clin Cases. Oct 6, 2025; 13(28): 109364
Published online Oct 6, 2025. doi: 10.12998/wjcc.v13.i28.109364

Middle meningeal artery embolisation in chronic subdural hematoma: A double-edged sword

Arvind K Morya, Ranjan K Behera, Parul C Gupta

Arvind K Morya, Department of Ophthalmology, All India Institute of Medical Sciences, Hyderabad 508126, Telangana, India

Ranjan K Behera, Parul C Gupta, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandīgarh 160012, UT Chandīgarh, India

Co-first authors: Arvind K Morya and Ranjan K Behera.

Author contributions: Behera RK and Morya AK conceptualized the manuscript; Gupta PC did the literature search, and all three edited and wrote the manuscript; Morya AK submitted the final edited manuscript with all the necessary documents.

Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.

Corresponding author: Arvind K Morya, MD, Professor, Research Professor, Senior Researcher, Department of Ophthalmology, All India Institute of Medical Sciences, Bibi Nagar, Hyderabad 508126, Telangana, India. bulbul.morya@gmail.com

Received: May 9, 2025
Revised: May 22, 2025
Accepted: July 17, 2025
Published online: October 6, 2025
Processing time: 91 Days and 2.4 Hours

Abstract

Chronic subdural hematoma is essentially managed by surgical intervention. In recent times, middle meningeal artery embolisation has emerged as a less invasive procedure in such cases. The use of fine catheters to selectively embolise the specific involved branches of the middle meningeal artery using polyvinyl alcohol particles looks promising; however, the presence of anastomotic arteries can result in reflux and embolisation of these atypical branches, causing a myriad of complications. There is a need to identify these abnormal vessels in time to have a positive outcome with the least complications.

Keywords: Subdural hematoma; Middle meningeal artery; Polyvinyl alcohol; Diplopia; Embolization

Core Tip: Chronic subdural hematoma management involves middle meningeal artery embolisation in association with standard surgical procedures. The embolisation procedure selectively blocks the involved artery but may result in other local complications due to anastomotic arteries. Identifying these abnormal branches and adapting to alternate materials and interventional techniques is essential to prevent such issues.