Embolization of the middle meningeal artery for acute epidural hematoma: illustrative case.

backgroundAcute epidural hematoma (AEDH) is a life-threatening traumatic brain injury typically managed with emergency craniotomy. Endovascular embolization of the middle meningeal artery (MMA) is effective in controlling hemorrhage and preventing epidural hematoma evacuation. In previous studies, concomitant surgical interventions have been commonly applied for other intracranial lesions. Transarterial embolization (TAE), the only definitive treatment that can completely eliminate the need for surgery in all associated intracranial pathologies, is rarely performed. OBSERVATIONS: Here, the authors present the case of a 24-year-old female patient with AEDH who exhibited a leakage sign on CT angiography, which was indicative of active bleeding and possible hematoma expansion. Immediate MMA embolization was performed. Hemostasis was achieved using coils, without the need for surgical interventions. The patient had favorable outcomes, including resolution of headache, absence of neurological deficits, and complete hematoma regression at 1 month. Craniotomy was not performed, and the patient had high satisfaction in terms of cosmetic outcomes. LESSONS: TAE can be a safe and effective primary treatment for AEDH in some patients. In particular, it can completely prevent surgery and its associated morbidities. Early endovascular intervention for leakage signs should be promptly considered to achieve rapid hemostasis and prevent hematoma expansion, even with limited surgical access. https://thejns.org/doi/10.3171/CASE25521.