2026 American Academy of Neurology Abstract Website

Gabriela Carolino¹, Aluisio D'Lucas Gomes², Amanda Rabelo³, Isabela dos Santos¹, Carolina Côrrea⁴, Julia Oliveira⁵, Tácio Batista¹, Maria Eduarda Valverde¹, Isabelle Alves¹, Igor Vinicius de Mello⁶, José Ricardo Vanzin⁷, Luciano Manzato⁷
¹Faculty of Medical and Health Sciences FCMS/JF, ²Medicine, Federal University of Ceará, ³Faculty of Medicine of Bauru - USP, ⁴Faculty of Medical Sciences of Minas Gerais - FCMMG, ⁵Pontifical Catholic University of Minas Gerais- PUC/MG, ⁶University of Valença (UNIFAA), ⁷Hospital das Clínicas de Passo Fundo

Objective:

To evaluate the efficacy and safety of MMAE plus standard therapy versus standard therapy alone, stratified by timing of intervention.

Background:

Chronic subdural hematoma (cSDH) is increasingly prevalent in the elderly due to aging and antithrombotic use. Burr-hole drainage remains the standard treatment, but recurrence rates are high. Middle meningeal artery embolization (MMAE) has emerged as an adjunctive strategy to disrupt dural neovascularization and prevent rebleeding.

Design/Methods:

RCTs were searched in PubMed, Embase, and Cochrane Central to July 2025. Eligible studies included adults with confirmed cSDH. Primary outcome: hematoma recurrence or persistence. Secondary outcomes: reoperation, hematoma resorption, serious adverse events, neurological death, mortality, and functional independence. Risk of bias was assessed with RoB-2, following PRISMA and Cochrane guidelines. Pooled analyses with 95% CIs were conducted using Review Manager 5.4. (PROSPERO CRD420251112841).

Results:

Seven RCTs (1,889 patients) were included. MMAE significantly reduced recurrent/residual cSDH (RR: 0.63; 95% CI: 0.46–0.85) and the need for reoperation (RR: 0.39; 95% CI: 0.28–0.56), without increasing serious adverse events (RR: 0.87; 95% CI: 0.72–1.06), neurological death, mortality, or poor functional outcomes. Hematoma volume resorption showed no significant difference. Sensitivity analyses confirmed robustness. Subgroup analyses showed consistent benefit for reducing reoperation across age groups, timing, follow-up periods, and bias categories, while recurrence, adverse events, and mortality were not significantly affected. Three studies were low risk of bias, two had some concerns, and two were high risk.

Conclusions:

MMAE combined with standard therapy significantly reduces recurrence and reoperation in cSDH without increasing adverse events or mortality. Its benefit appears independent of procedure timing. Larger RCTs with longer follow-up are needed to define long-term impact and optimal use.