Chen CY, Hsu YH. Complete resolution of massive chronic subdural hematoma with refined layered middle meningeal artery embolization: A case report. World J Clin Cases 2026; 14(7): 116694 [DOI: 10.12998/wjcc.v14.i7.116694]
Corresponding Author of This Article
Chia-Yu Chen, MD, Department of Neurosurgery, Kaohsiung Veterans General Hospital, No. 386 Dazhong 1st Road, Zuoying District, Kaohsiung 813414, Taiwan. cychen2@vghks.gov.tw
Research Domain of This Article
Neurosciences
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 6, 2026; 14(7): 116694 Published online Mar 6, 2026. doi: 10.12998/wjcc.v14.i7.116694
Complete resolution of massive chronic subdural hematoma with refined layered middle meningeal artery embolization: A case report
Chia-Yu Chen, Yu-Hone Hsu
Chia-Yu Chen, Yu-Hone Hsu, Department of Neurosurgery, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
Chia-Yu Chen, Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung 804201, Taiwan
Yu-Hone Hsu, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan
Co-corresponding authors: Chia-Yu Chen and Yu-Hone Hsu.
Author contributions: Chen CY collected and interpreted the clinical data, conducted the literature review, and drafted the manuscript; Hsu YH performed the middle meningeal artery embolization and critically revised the manuscript for important intellectual content; Chen CY and Hsu YH contributed equally to this manuscript as co-corresponding authors. All authors have reviewed and approved the final version of the manuscript.
Supported by Kaohsiung Veterans General Hospital, No. KSVGH115-018.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: Dr. Chen reports grant from Kaohsiung Veterans General Hospital, during the conduct of the study.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Chia-Yu Chen, MD, Department of Neurosurgery, Kaohsiung Veterans General Hospital, No. 386 Dazhong 1st Road, Zuoying District, Kaohsiung 813414, Taiwan. cychen2@vghks.gov.tw
Received: November 18, 2025 Revised: January 5, 2026 Accepted: February 11, 2026 Published online: March 6, 2026 Processing time: 107 Days and 15.4 Hours
Abstract
BACKGROUND
Chronic subdural hematoma (cSDH) is typically surgically managed; however, middle meningeal artery embolization (MMAE) has recently gained attention as a minimally invasive alternative. Optimal embolization techniques and patient selection criteria remain under investigation. Here, we present a refined embolization strategy - the layered embolization technique - which enhances distal penetration and procedural safety, representing a potential advancement in MMAE for cSDH.
CASE SUMMARY
A 78-year-old female with bilateral symptomatic cSDH and significant mass effect was unsuitable for surgery due to advanced age, comorbidities, and religious considerations. Standalone MMAE using a refined layered technique achieved complete hematoma resolution and full brain re-expansion within 3 months, without complications. The layered embolization technique involved initial deep penetration of the distal neovascular branches using low-concentration particles, followed by proximal vessel occlusion with standard-concentration particles under continuous fluoroscopic guidance. This controlled approach optimizes distal embolization, minimizes premature reflux, and facilitates complete hematoma clearance. Our case illustrates the potential for broader application of upfront MMAE, even in symptomatic cSDH with large hematomas.
CONCLUSION
Standalone MMAE using layered embolization is safe and effective for managing cSDH with significant mass effect in high-risk surgical candidates.
Core Tip: This case demonstrates a refined layered embolization technique as a novel approach for treating chronic subdural hematoma with significant mass effect. By employing sequential low- and standard-concentration embolic suspensions, the technique achieves deep distal penetration and proximal sealing, facilitating complete hematoma clearance within three months. This approach expands the therapeutic role of middle meningeal artery embolization to high-risk or surgically unsuitable patients.
