Adjunctive middle meningeal artery embolization for chronic subdural hematoma: A systematic review and meta-analysis of clinical trials.

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.