Introduction: Chronic subdural hematoma is one of the most common diseases requiring a neurosurgical op- eration that affect elderly and fragile patients. In addition to standard neurosurgical operations (trepanation and cra- niotomy), embolization of the middle meningeal artery (MMA) is an alternative solution.

Aims: Several summary studies have confirmed the very high rate of success and safety of the endovascular treatment.

Methods: In November 2019, we performed the first middle meningeal artery embolization, to our knowl- edge, the first in the country. During the following 18 months, a total of 10 cases of residual subdural hemato- ma were treated with this neurointervention procedure. We present the technical details and results of our 10 consecutive selective media meningeal artery emboli- zation procedures for residual chronic subdural hema- tomas. We treated 9 male and one female patient. The average age of the patients was 62.9 years, the youngest was 47 years old, while the oldest was 80 years old. We made a road map image with a 4 French size catheter in the external carotid artery, then we entered the main trunk of the middle meningeal artery with a microcath- eter, where selective embolization was performed with 250-355 micrometer polyvinyl alcohol (PVA) particles. The duration of the interventions was between 15 and 30 minutes.

Result: Our interventions were performed without complications and all resulted in complete recovery. One month after the intervention, all subdural hematomas were reduced by more than 50%, and every patient was asymptomatic. After 3 months, the subdural hematoma of 9 patients disappeared, while we lost one patient 2 months after surgery due to COVID pneumonia and sepsis.

Conclusion: MMA embolization can be considered a successful alternative to conservative treatment of asymp- tomatic chronic subdural hematoma. MMA embolization is an alternative or complementary treatment to surgical treatment for symptomatic chronic subdural hematoma. Multicentric, randomized trials are currently underway, so the evidence for MMA treatment of chronic subdural hematoma is currently considered low.