Middle Meningeal Artery Embolization for the Management of Chronic Subdural Hematoma: Updated Systematic Review and Meta-Analysis

Abstract

Background— Embolization of the middle meningeal artery (MMA) has emerged as a treatment strategy for
chronic subdural hematoma (cSDH). We performed a systematic review and a meta-analysis of currently published
literature on MMA embolization in patients with cSDH.
Methods— We searched Pubmed, Medline, and Cochrane databases for all studies that described the use of MMA
embolization in patients with cSDH. We conducted a meta-analysis on the resulting studies and calculated event
rates of treatment failure, procedural complications, and clinical and radiological improvements. From studies that
compared MMA embolization with conventional treatment, we calculated the rates of treatment failure as an outcome
of both methods using a fixed effects model.
Results— In this review, we included eleven studies with 212 total cases of cSDH treated with MMA embolization.
While the average length of time to follow-up evaluation ranged widely between studies (1 month to 4 years), of
the included patients in this review, 97.2% (95% confidence intervals [CI] 94.2 to 100) showed reduced cSDH size;
96.8% (95% CI 93.8 to 99.8) showed improvement on the modified Rankin Scale (mRS). Overall procedural com
-
plications were reported in 0.2% (95% CI -1.8 to 2.1) of patients. Three studies comparing MMA embolization and
conventional treatment demonstrated that MMA embolization was associated with lower rates of treatment failure
defined as cSDH recurrence or persistence of cSDH of a width of greater than 10mm (odds ratio [OR] 0.06 CI 95%
0.02 - 0.23, P<0.01; I
2
:0.0%).

Conclusion— Our meta-analysis shows that MMA embolization is effective in reducing cSDH volume and was
associated with lower rates of treatment failure when compared with conventional therapy. Randomized clinical trials
examining MMA embolization as a potential standard therapy in patients with cSDH are required.