# Adjunctive role of middle meningeal artery embolization in patients with surgical treatment of unilateral chronic subdural hematoma: a systematic review and meta-analysis of randomized controlled trials

## TL;DR

This study finds that adding middle meningeal artery embolization to surgery for chronic subdural hematoma reduces the need for reoperations.

## Contribution

The study provides the first meta-analysis of randomized trials on MMAE as an adjunct to cSDH surgery.

## Key findings

- MMAE reduced reoperation rates from 6.0% to 2.5% in patients with chronic subdural hematoma.
- There was no significant heterogeneity in the effect of MMAE on reoperation rates.
- Recurrence rates were lower with MMAE, but the difference was not statistically significant.

## Abstract

Chronic subdural hematoma (cSDH) is a common neurological condition, with high recurrence rates after surgical evacuation, posing significant challenges for patient outcomes. Middle meningeal artery embolization (MMAE) has emerged as a potential adjunctive therapy to reduce recurrence and reoperation rates. This meta-analysis evaluates the impact of MMAE on recurrence and reoperation rates in surgically treated unilateral subdural hematoma patients.

A systematic review and meta-analysis were conducted, adhering to PRISMA guidelines. Randomized controlled trials comparing surgical evacuation with and without adjunctive MMAE were included. The primary outcomes were recurrence and reoperation rates within 90 days. Pooled odds ratios (ORs) were calculated using a random-effects model. Statistical heterogeneity was assessed using the I2 statistic.

Two trials involving 965 patients met inclusion criteria. 478 patients underwent surgery with MMAE, and 487 patients underwent only surgery. MMAE reduced reoperation rates from 6.0% in controls to 2.5% in the MMAE group (OR: 0.41, 95% CI: 0.20–0.82; p = 0.01), with no significant heterogeneity (I2 = 0%). Recurrence rates were lower in the MMAE group (5.2% vs. 9.2%, OR: 0.52, 95% CI: 0.17–1.59; p = 0.25), but the difference was not statistically significant.

MMAE significantly reduces the risk of reoperation in surgically treated unilateral subdural hematoma patients and may also reduce recurrence rates. These findings support the integration of MMAE as an adjunct to surgery in selected patients.

Infographic summarizing a systematic review and meta-analysis on middle meningeal artery embolization as an adjunct to surgery for unilateral subdural hematoma. It shows 965 patients from randomized controlled trials, with lower reoperation rates in the embolization group (2.5%) compared to control (6.0%), and an odds ratio of 0.41 favoring embolization.