SIR Today

Middle Meningeal Artery Embolization vs Surgery-First for Traumatic Subdural Hemorrhage: A Propensity-Matched Multicenter Cohort Study

Schavee,J. Panaro, G. Cohen, J. Meshekow

New data indicates that middle meningeal artery embolization (MMAE) as a first-line response for adults with traumatic subdural hemorrhage (tSDH) may be associated with lower mortality, compared with surgical treatment.

“Our goal was to determine whether MMAE, which is increasingly used in chronic subdural hematoma (cSDH), may also represent a clinically meaningful treatment strategy in the traumatic setting rather than a technical alternative to surgery,” said Peter Schavee, presenting author at SIR 2026. “We hoped that with a large sample size, we would be able to elucidate with greater confidence the differences between these treatment strategies.”

cSDH, which is characterized by abnormal accumulation of fluid and blood within the brain, is traditionally treated via surgical removal of the hematoma. However, MMAE has gained substantial momentum in the management of cSDH, supported by growing observational and randomized data—yet there appeared to be a dearth of information regarding its effects in the traumatized patient, according to researchers.

Clinically, tSDH patients often present with significant comorbidities, frailty, or operative risk, raising the question of whether less invasive strategies could improve both short term and long-term outcomes, researchers said. This prominent gap in literature coupled with the rising popularity of MMAE in the treatment for cSDH prompted researchers to investigate the matter on a larger scale.

Researchers performed a retrospective cohort analysis using data from the federated TriNetX electronic health record network, which includes 107 participating health-care organizations. They identified 1,263 eligible patients in each group—those who received MMAE, and those who underwent surgery. After reviewing the data, they concluded that MMAE showed lower mortality than surgery after 30 days.

“We did observe an increase in subsequent cranial procedures, but interestingly there were no differences in hospital readmission rates between treatment strategies,” Schavee said.

There were also reduced rates of acute seizures and chronic seizure disorders in patients treated with MMAE.

“These associations were consistent across multiple time points following robust adjustment for baseline differences,” he said. “Our results support the idea that MMAE may offer more than procedural convenience, it may meaningfully influence patient outcomes and should be considered earlier in the treatment algorithm for selected tSDH patients in comparison to classical surgical management.”

Further research into this subject is planned.

“Our study clearly demonstrates that tSDH can meaningfully be treated with MMAE. However, the power of the study comes with decreased granularity of data,” Schavee said, adding that he and his team hope to conduct future work incorporating pre- and post-radiographic indications combined with clinical status, functional recovery.

“Prospective or randomized comparisons may help clarify causality and optimize treatment pathways,” he said. “In addition, we want to conduct longitudinal analyses examining recurrence and quality-of-life outcomes, such as with more discrete functional neurological recovery status.”

Although observational in nature, Schavee believes the consistency of their findings across multiple clinical outcomes and time points underscores the potential role of MMAE as a paradigm-shifting approach to tSDH management.

“We hope this work contributes to future discussions about expanding minimally invasive options while prioritizing and improving patient-centered outcomes,” he said.