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Middle meningeal artery (MMA) embolization has emerged as a minimally invasive treatment. We describe the case of an 85-year-old man with refractory CSDH who developed multiple recurrences despite repeated surgical evacuation and MMA embolization. Three-dimensional rotational angiography (3D-RA) revealed atypical transosseous feeders from the anterior and middle deep temporal arteries and the middle temporal artery. Targeted embolization using N-butyl cyanoacrylate and coils resulted in durable hematoma resolution without further recurrence. This case highlights the importance of detailed vascular assessment with 3D-RA when MMA embolization fails.<\/jats:p>","DOI":"10.1007\/s00701-026-06882-8","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T19:35:03Z","timestamp":1776368103000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Failure of MMA embolization due to deep and middle temporal artery supply in chronic subdural hematoma: the diagnostic value of 3D-RA"],"prefix":"10.1007","volume":"168","author":[{"given":"Masaomi","family":"Takeuchi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7135-2220","authenticated-orcid":false,"given":"Yoichi","family":"Morofuji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Matsunaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chieko","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eri","family":"Shiozaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Matsuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"6882_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2176\/nmccrj.2013-0343","volume":"1","author":"H Chihara","year":"2014","unstructured":"Chihara H, Imamura H, Ogura T, Adachi H, Imai Y, Sakai N (2014) Recurrence of a refractory chronic subdural hematoma after middle meningeal artery embolization that required craniotomy. 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