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Background <p>Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition with high recurrence rates after standard surgical evacuation. Middle meningeal artery embolization (MMAE) has emerged as a potential adjunct to reduce recurrence by targeting the vascular supply of neomembranes.</p> Objective <p>To evaluate the efficacy and safety of MMAE combined with surgery versus standalone surgical evacuation in patients with CSDH, through a comprehensive systematic review and meta-analysis, including separate analysis of randomized controlled trials (RCTs).</p> Methods <p>A systematic search of PubMed, Scopus, Web of Science, Embase, and Google Scholar was performed through March 2025. Dual-arm studies comparing MMAE plus surgery with surgery alone were included. Outcomes of interest were recurrence, complications, all-cause mortality, and functional outcome (modified Rankin Scale ≤ 2; mRS ≤ 2). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects model. Bias and evidence certainty were assessed via RoB tools and GRADE.</p> Results <p>Twenty-five studies (6 RCTs, 19 observational) comprising 119,812 patients were included. MMAE plus surgery significantly reduced recurrence (RR = 0.47, 95% CI: 0.36–0.62, <i>p</i> &lt; 0.001; I² = 3.0%), without increasing complications (RR = 1.02, 95% CI: 0.8–1.3) or mortality (RR = 0.98, 95% CI: 0.72–1.33) compared with surgery alone. Functional outcomes were similar between both approaches (RR = 1.07, 95% CI: 0.93–1.23). Subanalysis of RCTs, was consistent with overall analysis showing a significant reduction in recurrence (RR = 0.44, 95% CI: 0.25–0.78) with MMAE plus surgery, without an increase in complications or mortality compared to surgery alone.</p> Conclusion <p>MMAE as an adjunct to surgery significantly lowers recurrence in CSDH. No significant differences in complications, mortality, or functional outcomes were detected compared with surgery alone; however, these outcomes are less common, and available studies may not have been adequately powered to exclude small but clinically meaningful effects.</p>

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Efficacy of middle meningeal artery embolization combined with surgery versus standalone surgery for chronic subdural hematoma: a comprehensive systematic review and Meta-Analysis with separate analysis of randomized controlled trials

  • 期刊论文

  • 发表日期：

    2025年10月16日

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  • Ibrahim Mohammadzadeh,
  • Bardia Hajikarimloo,
  • Amirhossein Zare,
  • Shahin Mohammadzadeh,
  • Pooya Eini,
  • Saba Aghajani,
  • Ali Mortezaei,
  • Mohammad Amin Habibi,
  • Kivanc Yangi,
  • Ahmet Günkan,
  • Pascal Jabbour

摘要

Background

Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition with high recurrence rates after standard surgical evacuation. Middle meningeal artery embolization (MMAE) has emerged as a potential adjunct to reduce recurrence by targeting the vascular supply of neomembranes.

Objective

To evaluate the efficacy and safety of MMAE combined with surgery versus standalone surgical evacuation in patients with CSDH, through a comprehensive systematic review and meta-analysis, including separate analysis of randomized controlled trials (RCTs).

Methods

A systematic search of PubMed, Scopus, Web of Science, Embase, and Google Scholar was performed through March 2025. Dual-arm studies comparing MMAE plus surgery with surgery alone were included. Outcomes of interest were recurrence, complications, all-cause mortality, and functional outcome (modified Rankin Scale ≤ 2; mRS ≤ 2). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects model. Bias and evidence certainty were assessed via RoB tools and GRADE.

Results

Twenty-five studies (6 RCTs, 19 observational) comprising 119,812 patients were included. MMAE plus surgery significantly reduced recurrence (RR = 0.47, 95% CI: 0.36–0.62, p < 0.001; I² = 3.0%), without increasing complications (RR = 1.02, 95% CI: 0.8–1.3) or mortality (RR = 0.98, 95% CI: 0.72–1.33) compared with surgery alone. Functional outcomes were similar between both approaches (RR = 1.07, 95% CI: 0.93–1.23). Subanalysis of RCTs, was consistent with overall analysis showing a significant reduction in recurrence (RR = 0.44, 95% CI: 0.25–0.78) with MMAE plus surgery, without an increase in complications or mortality compared to surgery alone.

Conclusion

MMAE as an adjunct to surgery significantly lowers recurrence in CSDH. No significant differences in complications, mortality, or functional outcomes were detected compared with surgery alone; however, these outcomes are less common, and available studies may not have been adequately powered to exclude small but clinically meaningful effects.