Middle Meningeal Artery Embolisation in Chronic Subdural Hematoma (EMMA-CS)

Inclusion Criteria:

• Age 18 years or older.
• Diagnosis of a symptomatic or asymptomatic chronic or subacute subdural hematoma (cSDH) confirmed by neuroimaging (CT or MRI).
• Hematoma thickness of 5 mm or greater at its widest point on baseline neuroimaging.
• Patient is managed either conservatively or via standard surgical evacuation (e.g., burr-hole craniostomy) where MMAE is planned as a standalone or adjunctive treatment.
• Written informed consent provided by the patient or a legally authorized representative.

Exclusion Criteria:

• Acute subdural hematoma requiring emergency surgical decompression due to severe neurological deficit with signs of impending herniation.
• Evidence of an active intracranial infection or sepsis.
• Known vascular malformation, aneurysm, or dural arteriovenous fistula as the source of the hematoma.
• Severe uncorrectable coagulopathy or bleeding disorder (e.g., platelet count <50,000/µL or INR >2.0 that cannot be safely corrected before the procedure).
• Severe renal impairment (e.g., eGFR <30 mL/min/1.73m²) or known severe allergy to iodinated contrast media (unless adequate premedication is possible).
• Life expectancy of less than 3 months due to severe comorbid conditions.