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This systematic review and meta-analysis assessed whether adding middle meningeal artery embolization (MMAE) to surgical evacuation reduces recurrence of chronic subdural hematoma compared with surgery alone. Eight randomized trials involving 1,961 patients were included. Adjunctive MMAE was associated with a significantly lower risk of recurrence (RR, 0.63; 95% CI, 0.46–0.85), with no observed statistical heterogeneity for this outcome (\(I^2 = 0\%\)). Trial sequential analysis supported the recurrence finding. Although conventional meta-analysis suggested fewer repeat operations, the trial sequential analysis indicated that this result was less robust to analytical assumptions. Safety outcomes were comparable between treatment groups. Exploratory analyses suggested that patient age and anticoagulation use might help explain differences between studies, but these findings were hypothesis-generating because they used aggregate-level data from a limited number of trials. Conclusion: Adjunctive MMAE appears to reduce chronic subdural hematoma recurrence without a clear increase in adverse events, but its effects on reoperation and other patient-centered outcomes require further evaluation.
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This systematic review and meta-analysis assessed whether adding middle meningeal artery embolization (MMAE) to surgical evacuation reduces recurrence of chronic subdural hematoma compared with surgery alone. Eight randomized trials involving 1,961 patients were included. Adjunctive MMAE was associated with a significantly lower risk of recurrence (RR, 0.63; 95% CI, 0.46–0.85), with no observed statistical heterogeneity for this outcome (\(I^2 = 0\%\)). Trial sequential analysis supported the recurrence finding. Although conventional meta-analysis suggested fewer repeat operations, the trial sequential analysis indicated that this result was less robust to analytical assumptions. Safety outcomes were comparable between treatment groups. Exploratory analyses suggested that patient age and anticoagulation use might help explain differences between studies, but these findings were hypothesis-generating because they used aggregate-level data from a limited number of trials. Conclusion: Adjunctive MMAE appears to reduce chronic subdural hematoma recurrence without a clear increase in adverse events, but its effects on reoperation and other patient-centered outcomes require further evaluation.
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