Middle meningeal artery patency after surgical evacuation for chronic subdural hematoma

Chronic subdural hematoma (CSDH) often requires surgical evacuation, but recurrence rates remain high. Middle meningeal artery (MMA) embolization (MMAE) has been proposed as an alternative or adjunct treatment. There is concern that prior surgery might limit patency, access, penetration, and efficacy of MMAE, such that some recent trials excluded patients with prior craniotomy. However, the impact of prior open surgery on MMA patency has not been studied. A retrospective analysis was conducted on patients who underwent MMAE for cSDH (2019–2022), after prior surgical evacuation or not. MMA patency was assessed using a six-point grading scale. Of the 109 MMAEs (84 patients, median age 72 years, 20.2