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Meta-Analysis
. 2021 Aug;27(4):577-583.
doi: 10.1177/1591019921990962. Epub 2021 Feb 1.

Risk of recurrence of subdural hematoma after EMMA vs surgical drainage - Systematic review and meta-analysis

Joshua Dian  1 , Janice Linton  2 , Jai Js Shankar  3
Affiliations
Meta-Analysis

Risk of recurrence of subdural hematoma after EMMA vs surgical drainage - Systematic review and meta-analysis

Joshua Dian et al. Interv Neuroradiol. 2021 Aug.

Abstract

Objective: Chronic subdural hematoma (CSDH) is a common and debilitating neurological condition whose treatments, including burr hole drainage and craniotomy, suffer from high rates of recurrence and complication. Embolization of the middle meningeal artery (EMMA) is a promising minimally invasive approach to manage CSDH in a broad set of patients.

Methods: To evaluate the efficacy and safety of EMMA, a database search was conducted including the terms "subdural hematoma; embolization; embolized; middle meningeal" was performed and yielded a total of 260 results. Following exclusion based on predefined criteria, a total of four studies were identified and outcomes including recurrence rates and complication rates were extracted for analysis.

Results: Four studies including intervention and control groups were included with a total of n = 888 patients. The relative risk of CSDH recurrence in the EMMA (3.5%) compared to control group (23.5%) was significantly reduced when EMMA was performed (risk ratio = 0.17; 95% confidence interval (CI) 0.05-0.67). In addition, rates of complication were not significantly different between patients with conventional therapy and those who received EMMA (OR = 0.77; 95 confidence interval (CI) 0.3-1.99).

Conclusion: Based on limited data, EMMA reduces the risk of recurrence by 20% compared to surgical treatment for CSDH.

Keywords: Embolization; chronic subdural hematoma; craniotomy; surgical drainage.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram using PRISMA methodology showing stages of article selection and final studies included for meta-analysis.
Figure 2.
Figure 2.
Forest plot showing recurrence rates in individual studies and pooled across studies.
Figure 3.
Figure 3.
Forest plots showing rates of complication in individual studies and pooled across studies.
See this image and copyright information in PMC

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