Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Apr 11;48(1):358.
doi: 10.1007/s10143-025-03464-7.

Middle meningeal artery embolization for chronic subdural hematoma: a meta-analysis of randomized controlled trials with trial sequential analysis

Gabriel de Almeida Monteiro  1 , Antonio Mutarelli  2 , Ocílio Ribeiro Gonçalves  3 , Gabriel Marinheiro  4 , Laís Santana  5 , Christian Ken Fukunaga  6 , Joaquim Francisco Cavalcante-Neto  7 , Marianna Leite  8 , Keven Ferreira da Ponte  4 , Paulo Roberto Lacerda Leal  4 , Gerardo Cristino-Filho  4 , Davi Jorge Fontoura Solla  9 , Ahmet Günkan  10 , Marcio Yuri Ferreira  11 , Christian Ferreira  12 , David Gordon  12 , Yafell Serulle  11
Affiliations
Meta-Analysis

Middle meningeal artery embolization for chronic subdural hematoma: a meta-analysis of randomized controlled trials with trial sequential analysis

Gabriel de Almeida Monteiro et al. Neurosurg Rev. .

Abstract

Middle meningeal artery embolization (MMAE) has gained attention as an innovative approach for chronic subdural hematoma (cSDH). It can be utilized either as a standalone treatment or as an adjunct to surgical evacuation, with the primary goal of reducing the risk of cSDH recurrence. Therefore, we aim to investigate the efficacy and safety of MMAE in cSDH patients. Databases were systematically searched for randomized controlled trials (RCTs) reporting the use of MMAE in cSDH patients. All statistical analyses were performed using Review Manager 5.4.1. We employed risk ratio (RR) and Mean Differences (MD) with 95% confidence intervals (CIs) as the measure of effect size using a random-effects model. We included seven RCTs (1,623 patients; mean age, 72.7 ± 10.9 [MMAE group] and 72.3 ± 11.0 [usual-care group] years; 74.9% [MMAE] and 77.3% [usual-care] were male). MMAE significantly reduced recurrence (RR 0.47, 95% CI: 0.34 to 0.65, p < 0.001). No statistically significant differences were observed in good (RR 1.01, 95% CI: 0.97 to 1.05, p = 0.77) and favorable functional outcome (RR 1.01, 95% CI: 0.96 to 1.07, p = 0.69). Hematoma volume was only significantly reduced in the adjunctive MMAE subgroup analysis (MD -6.49, 95% CI: -12.21 to -0.78, p = 0.03). No statistically significant differences were observed in adverse events (RR 0.97, 95% CI: 0.68 to 1.39, p = 0.885), serious adverse events (RR 0.78, 95% CI: 0.59 to 1.04, p = 0.09), and mortality (RR 0.98, 95% CI: 0.42 to 2.30, p = 0.97). MMAE significantly reduced recurrence risk compared to usual care, with benefits observed in adjunctive MMAE, including lower reoperation rates and reduced hematoma volume at 90 days. Functional outcomes at 90 days were not significantly different between groups. Similarly, adverse events and mortality rates were comparable between groups Clinical trial number: Not applicable.

Keywords: Chronic subdural hematoma; Embolization; Middle meningeal artery; Onyx; Recurrence.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethical approval: Ethical approval is not required for this study. Human ethics and consent to participate: Not applicable. Informed consent: Informed consent is not required for this study. Competing interests: The authors declare no competing interests.

References

    1. Almenawer SA, Farrokhyar F, Hong C, Alhazzani W, Manoranjan B, Yarascavitch B, Arjmand P, Baronia B, Reddy K, Murty N, Singh S (2014) Chronic subdural hematoma management: a systematic review and meta-analysis of 34,829 patients. Ann Surg 259:449–457. https://doi.org/10.1097/SLA.0000000000000255 - DOI - PubMed
    1. Balser D, Farooq S, Mehmood T, Reyes M, Samadani U (2015) Actual and projected incidence rates for chronic subdural hematomas in united States veterans administration and civilian populations. https://doi.org/10.3171/2014.9.JNS141550
    1. Chari A, Hocking KC, Edlmann E, Turner C, Santarius T, Hutchinson PJ, Kolias AG (2016) Core outcomes and common data elements in chronic subdural hematoma: A systematic review of the literature focusing on baseline and Peri-Operative care data elements. J Neurotrauma 33:1569–1575. https://doi.org/10.1089/neu.2015.4248 - DOI - PubMed
    1. Davies JM, Knopman J, Mokin M, Hassan AE, Harbaugh RE, Khalessi A, Fiehler J, Gross BA, Grandhi R, Tarpley J, Sivakumar W, Bain M, Crowley RW, Link TW, Fraser JF, Levitt MR, Chen PR, Hanel RA, Bernard JD, Jumaa M, Youssef P, Cress MC, Chaudry MI, Shakir HJ, Lesley WS, Billingsley J, Jones J, Koch MJ, Paul AR, Mack WJ, Osbun JW, Dlouhy K, Grossberg JA, Kellner CP, Sahlein DH, Santarelli J, Schirmer CM, Singer J, Liu JJ, Majjhoo AQ, Wolfe T, Patel NV, Roark C, Siddiqui AH (2024) Adjunctive middle meningeal artery embolization for subdural hematoma. N Engl J Med 391:1890–1900. https://doi.org/10.1056/NEJMoa2313472 - DOI - PubMed
    1. Debs LH, Vale FL, Walker S, Toro D, Mansouri S, Macomson SD, Rahimi SY (2024) Middle meningeal artery embolization following surgical evacuation of symptomatic chronic subdural hematoma improves outcomes, interim results of a prospective randomized trial. J Clin Neurosci 128:110783. https://doi.org/10.1016/j.jocn.2024.110783 - DOI - PubMed

Publication types

LinkOut - more resources