Adjunct Middle Meningeal Artery Embolization Versus Surgery for Chronic Subdural Hematoma: A Systematic Review and Meta-analysis
Omar Abbas1, Roaa Haddad2, Youmna Zain3, Hala AbouShawareb4, Abdullah Almarfadi5, Afaf Bachira Gouhiri6, Mohab Saad1, Yousif Hanafi1, Mohamed A. Aldemerdash7, Mohamed Mohsen Helal8, Dalia Abouda9
1Faculty of Medicine, Al-Azhar University, Cairo, Egypt., 2Faculty of Medicine, October 6 University, Egypt., 3Faculty of Medicine, Tanta University, Egypt., 4Faculty of Medicine, Mansoura University, Egypt., 5Faculty of Medicine, Ferhat Abbas University of Setif, Algeria., 6Faculty of Medicine, Ben Youcef Ben Khedda University, Algiers, Algeria., 7Faculty of Medicine, Sohag University, Sohag, Egypt., 8Faculty of Medicine, Zagazig University, Egypt., 9Faculty of medicine, Alexandria university, Alexandria, Egypt
Objective:
This meta-analysis aimed to compare clinical outcomes between adjunctive MMAE combined with surgery and surgery alone in patients with cSDH
Background:
Chronic subdural haematoma (cSDH) is a prevalent neurosurgical condition with notable recurrence rates following surgical evacuation. Middle meningeal artery embolisation (MMAE) has emerged as a promising adjunct to reduce recurrence, yet its added benefit when combined with surgery remains inconsistent across studies.
Design/Methods:
A systematic search of six databases was conducted from inception to March 2025. The primary outcomes were treatment failure, reoperation rate, and length of hospital stay. Outcomes were reported as odds ratios (ORs) or standardised mean differences (SMDs) with 95% confidence intervals (CI). A random-effects model was used for all analyses.
Results:
Twenty studies published between 2017 and 2025, comprising 60,940 patients, met the inclusion criteria. MMAE significantly reduced the treatment failure rate (10.77% in the MMAE plus surgery group vs. 16.69% in the surgery-alone group; p = 0.04), though the certainty of evidence was low. No significant difference was observed in reoperation rates (6.96% vs. 3.26%; p = 0.19), with moderate certainty of evidence. Ten studies reported on hospital stay duration, showing no significant difference between groups (SMD = 0.19 days; 95% CI: –0.07 to 0.45; p = 0.15), with very low certainty of evidence.
Conclusions:
Our systematic review and meta-analysis suggest that adjunct MMAE to surgery is more safer and potentially more effective strategy than surgery alone. Ongoing randomised clinical trials may be needed in the future with a longer follow-up duration.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.