Advanced Neurovascular Treatment
A minimally invasive treatment for chronic subdural hematoma
Middle meningeal artery embolization targets blood vessels that can contribute to continued bleeding and recurrence—offering eligible patients a less invasive treatment option.
Minimally invasive
Treatment is performed through a catheter placed in an artery, without opening the skull.
Targets a source of recurrence
Embolization reduces blood flow through vessels that may continue feeding the hematoma membranes.
Planned around each patient
It may be considered as a standalone treatment or used alongside surgical drainage, depending on the individual case.
Understanding the problem
Why can a chronic subdural hematoma come back?
A chronic subdural hematoma is a collection of blood and fluid between the brain and its outer covering. Over time, membranes can form around the collection and develop fragile blood vessels that may continue to leak.
But drainage alone may not address the blood supply feeding those fragile membranes. That can allow the collection to persist or return.
A collection develops
Blood and fluid accumulate between the brain and its protective outer covering.
Fragile membranes form
New membranes and delicate blood vessels may develop around the hematoma.
Small vessels may keep leaking
Continued blood flow to the membranes can contribute to persistent or renewed bleeding.
The hematoma may return
The collection can enlarge again, potentially bringing symptoms back and requiring additional treatment.
The treatment
How MMA embolization interrupts the cycle
Instead of directly removing the hematoma, MMA embolization is designed to reduce blood flow to the membranes surrounding it, allowing the collection to gradually resolve.
A catheter is guided to the artery
Through a small access point, a neurointerventional specialist guides a thin catheter through the blood vessels to the middle meningeal artery.
Selected branches are embolized
Embolic material is delivered through the catheter to reduce blood flow to vessels supplying the membranes around the hematoma.
The collection can gradually resolve
With less blood reaching the membranes, continued leakage may be reduced while the body reabsorbs the hematoma over time.
It addresses part of the process that can allow a chronic subdural hematoma to persist or recur. Depending on the case, it may be used alone or alongside surgical drainage.
Inside the procedure
A precise view of the artery before treatment
This cerebral angiogram shows selective catheterization of the middle meningeal artery before embolization. Angiography allows the specialist to identify the relevant vascular anatomy and carefully plan treatment.
The evidence
Landmark trials show fewer treatment failures
Large randomized clinical trials have evaluated whether adding middle meningeal artery embolization to standard care can reduce recurrence, progression and the need for another operation.
EMBOLISE Trial · 2024
Lower risk of repeat surgery
Among 400 patients who required surgical evacuation, recurrence or progression leading to another operation occurred less often when MMA embolization was added to surgery.
Read the EMBOLISE studySTEM Trial · 2025
Lower risk of treatment failure
In this international randomized trial, treatment failure occurred less often when MMA embolization was added to surgical or nonsurgical standard treatment.
Read the STEM studyABS and the STEM trial
Bringing landmark clinical research to New Jersey
Ronald P. Benitez, MD, of Atlantic Brain and Spine treated the first patient enrolled in New Jersey in the STEM clinical trial—helping bring this evolving treatment approach to patients in the state.
What this may mean for patients
For appropriately selected patients, MMA embolization may reduce the likelihood that a chronic subdural hematoma will recur, progress or require another procedure. The best approach still depends on the hematoma, symptoms and the patient’s overall health.
These results reflect specific clinical-trial populations and treatment protocols. Individual outcomes vary, and not every patient is a candidate for MMA embolization.
A closer look
Treating the hematoma—and reducing the chance of return
This patient’s treatment combined drainage of the existing hematoma with MMA embolization to reduce blood flow to the surrounding membranes.
Recovery continued after treatment
The drain was removed two days after the procedure. The patient was discharged to acute rehabilitation and later returned home with support. At the three-month follow-up, imaging showed continued resolution without significant recurrence.
This individual case is presented for educational purposes. Results and recovery vary according to each patient’s condition and treatment plan.
Individualized treatment
Who may benefit from MMA embolization?
MMA embolization may be considered in several clinical situations. The right treatment depends on the size of the hematoma, the pressure it is placing on the brain, symptoms, previous treatment and overall health.
A neurovascular specialist evaluates the patient’s imaging and medical history to determine whether embolization, drainage, observation or a combined approach is most appropriate.
A hematoma that has returned
Embolization may be considered when a chronic subdural hematoma recurs or continues to enlarge after previous treatment.
Treatment alongside drainage
For a larger or symptomatic hematoma, MMA embolization may be added to surgical drainage to address both the collection and its blood supply.
A less invasive option is preferred
Some patients may benefit from a catheter-based approach that does not require an incision in the skull, when clinically appropriate.
Additional surgery carries concern
Embolization may be evaluated for older adults or patients whose health history makes repeated operations especially concerning.
Not sure whether this treatment fits your situation?
Our specialists can review your diagnosis, imaging and prior treatment and help identify the most appropriate next step.
Advanced neurovascular care
Expertise across endovascular and surgical treatment
Atlantic Brain and Spine brings together neurosurgical and endovascular expertise to evaluate chronic subdural hematomas from every angle. Treatment is selected around the patient—not around one particular procedure.
Advanced catheter-based neurovascular treatment
Traditional and minimally invasive surgical options
Individualized review of imaging, symptoms and medical history
Ready when you are
Talk with a specialist about your next step
Whether you have a new diagnosis, a recurrent hematoma or questions about a recommended treatment, our team can review your situation and help you understand your options.
