# middle meningeal artery embolization (MMAE)

This review reframes chronic subdural hematoma (cSDH) from a simple mechanical consequence of head trauma into a chronic, self-perpetuating disease driven by inflammation, pathological angiogenesis, and hyperfibrinolysis within an outer neomembrane, and on that basis summarizes patient- and hematoma-related risk factors, conventional conservative and surgical treatment, and contemporary evidence for middle meningeal artery embolization (MMAE) as a mechanism-targeted adjunct or alternative to surgery, alongside recurrence burden, cost-effectiveness, country-specific reimbursement exemplified by Korean practice, and emerging biomarker-based and artificial-intelligence-guided stratification and early transvascular access to the subdural space.

This review reframes chronic subdural hematoma (cSDH) from a simple mechanical consequence of head trauma into a chronic, self-perpetuating disease driven by inflammation, pathological angiogenesis, and hyperfibrinolysis within an outer neomembrane, and on that basis summarizes patient- and hematoma-related risk factors, conventional conservative and surgical treatment, and contemporary evidence for middle meningeal artery embolization (MMAE) as a mechanism-targeted adjunct or alternative to surgery, alongside recurrence burden, cost-effectiveness, country-specific reimbursement exemplified by Korean practice, and emerging biomarker-based and artificial-intelligence-guided stratification and early transvascular access to the subdural space.