To evaluate the efficacy and safety of middle meningeal artery embolization (MMAE) versus conventional management in patients with chronic subdural hematoma (cSDH) by synthesizing data from recent high-quality meta-analyses.

Chronic subdural hematoma is common in elderly patients and carries high recurrence rates after standard surgical evacuation. MMAE has emerged as a minimally invasive alternative or adjunctive therapy. However, definitive comparative evidence remains fragmented across multiple meta-analyses, varying in quality and scope.

This umbrella review followed PRISMA guidelines and included seven meta-analyses published through June 2025. Databases searched were PubMed, Scopus, Web of Science, and Google Scholar. Outcomes assessed included treatment failure, surgical rescue, mortality, complications, and modified Rankin Scale (mRS > 2). Overlap between reviews was quantified using corrected covered area (CCA), and methodological rigor was evaluated using the AMSTAR-2 tool.

MMAE significantly reduced treatment failure (RR range: 0.34–0.53) and surgical rescue rates (RR range: 0.29–0.36) compared to conventional approaches. Mortality and complication rates showed no significant difference (RR ~1.0). Functional outcomes (mRS > 2) were also similar (RR 0.78, 95% CI 0.49–1.25). Heterogeneity stemmed from variable comparator definitions (e.g., surgical vs conservative care), but newer meta-analyses with RCTs (e.g., Nie, Gonçalves, Elgendy) consistently supported MMAE’s benefit in reducing recurrence.

MMAE offers a substantial reduction in recurrence and need for reoperation without increasing mortality or disability, making it an effective and safe alternative or adjunct for cSDH, particularly in high-risk surgical candidates. Future studies should focus on standardizing outcome definitions, comparing embolic agents, and incorporating cost-effectiveness and quality-of-life measures to further guide practice.