NYMC Faculty Publications

Adjunctive Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis of Clinical Trials

Author Type(s)

Faculty, Student

Award

Research Article Published in Journal with Highest Impact Factor for All Authors (Journal Citation Reports 2023)

DOI

10.1016/j.jns.2025.123469

Journal Title

Journal of the Neurological Sciences

Document Type

Article

Publication Date

5-15-2025

Department

Neurosurgery

Second Department

Neurology

Keywords

meta-analysis, Middle meningeal artery embolization, Subdural hematoma

Disciplines

Medicine and Health Sciences

Abstract

Background: Chronic subdural hematoma (cSDH) is a common neurosurgical condition with high recurrence rates, particularly in elderly patients. The pathophysiology involves complex mechanisms of angiogenesis, fibrinolysis, and inflammation, leading to progressive hemorrhage and fluid accumulation. Aim: To systematically review and meta-analyze the clinical benefits and safety of middle meningeal artery embolization (MMAE) as an adjunctive treatment to usual care for cSDH. Methods: A comprehensive literature search was conducted across four electronic databases following PRISMA guidelines. Four clinical trials were included, involving 1680 patients with cSDH. Meta-analysis was performed using the Mantel-Haenszel method to calculate risk ratios and 95 % confidence intervals for key outcomes, including recurrence, mortality, functional outcomes, and complications. Results: MMAE plus usual care significantly reduced cSDH recurrence (Risk Ratio 0.56, 95 % CI [0.39 to 0.80], P = 0.001) and mortality (Risk Ratio [RR] 0.53, 95 % CI [0.31 to 0.91], P = 0.02) compared to usual care alone. No statistically significant differences were observed in functional outcomes (mRS 0–2 at 90 days), serious adverse events, or major disabling stroke between the two groups. Conclusion: MMAE as an adjunctive treatment shows promising results in reducing cSDH recurrence and mortality without increasing procedural risks, suggesting potential benefits in managing this challenging neurosurgical condition.

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