ArticleFrontiers in neurology2026
Adjunctive middle meningeal artery embolization with low-viscosity liquid embolic agents for acute epidural hematoma: technical considerations and a case series.
Article in Frontiers in neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To assess the feasibility, safety, and short-term outcomes of adjunctive middle meningeal artery (MMA) embolization using low-viscosity liquid embolic agents (1:1 diluted Onyx/DMSO and 1:9 diluted Glubran 2/Ethiodized Poppyseed Oil Injection) for acute epidural hematoma (AEDH). Methods: We retrospectively reviewed 9 consecutive AEDH patients evaluated for MMA embolization at our institution. Eight underwent embolization, and one was converted to immediate craniotomy after pre-procedural cranial CT showed rapid hematoma expansion. In the embolization subgroup, low-viscosity agents included 1:1 diluted Onyx with dimethyl sulfoxide (DMSO) ( Results: Technical success was achieved in all embolized cases (8/8). Across the eight embolized cases, low-viscosity agents reached distal dural branches without relevant proximal reflux, and no catheter adherence or catheter entrapment was observed. No procedure-related complications occurred. Follow-up imaging showed stable or resolving hematomas in all embolized patients, and none required rescue surgery for post-embolization expansion. Median discharge GCS was 15, and no new neurologic deficits were observed. In the non-embolized conversion case, immediate pre-procedural CT showed interval progression, and prompt craniotomy was performed. Conclusion: In selected AEDH patients, adjunctive MMA embolization with low-viscosity liquid embolic agents (1:1 diluted Onyx/DMSO and 1:9 diluted Glubran 2/ethiodized oil) was technically feasible with a favorable short-term safety profile and may help control bleeding and reduce the risk of hematoma expansion while balancing distal penetration and catheter control. This strategy may provide a minimally invasive treatment option for high-risk AEDH, but multicenter studies with larger retrospective case series are needed for confirmation.
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