Middle Meningeal Artery Embolization for Combined Traumatic Acute Epidural and Subdural Hematomas: A Case Report and Review of the Literature

Abstract

Background: Traumatic epidural hematoma (EDH) is classically associated with skull fracture and injury to the middle meningeal artery (MMA). Standard management includes emergent craniotomy for neurologically deteriorating patients and close observation for those who do not meet surgical criteria. Endovascular MMA embolization has emerged as an adjunctive or alternative strategy in select cases, though its role in acute traumatic EDH remains incompletely defined. A focused literature review was performed to identify published cases describing middle meningeal artery (MMA) embolization for acute traumatic epidural hematoma (EDH). Case Presentation: We report the case of a 17-year-old male who sustained blunt head trauma following an all-terrain vehicle rollover, resulting in a progressively enlarging acute epidural hematoma with an associated acute subdural hematoma. Despite radiographic progression, the patient remained neurologically intact and did not meet criteria for surgical evacuation. Cerebral angiography demonstrated active extravasation from the anterior branch of the middle meningeal artery, which was successfully treated with coil embolization. Post-procedural imaging demonstrated hematoma stability without mass effect or neurological decline. The patient had an uneventful clinical course and was discharged home without neurologic deficit. Conclusion: This case illustrates that middle meningeal artery embolization may be a feasible and effective therapeutic option for selected patients with traumatic epidural hematomas who remain neurologically stable but demonstrate radiographic progression. Careful patient selection and close neuroimaging surveillance remain essential.