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This systematic review and meta-analysis pooled 12 randomized controlled trials (2,429 patients; 1,202 MMAE, 1,227 control), including the 2026 EMMA-Can, G-MEMBRANE and MEMBRANE trials, to evaluate middle meningeal artery embolization (MMAE) for chronic subdural hematoma. Study-defined treatment failure occurred in 9.1% of patients with MMAE versus 18.3% with standard management (RR 0.52, 95% CI 0.39–0.69), corresponding to an absolute risk reduction of 8.8% and a number needed to treat of about 12. Reoperation or surgical rescue was also lower (4.4% vs 11.6%; RR 0.40, 95% CI 0.31–0.52). The benefit was consistent across surgery-only and mixed comparator subgroups (P for subgroup difference=0.317). All-cause mortality (RR 0.72, 95% CI 0.37–1.43) and severe adverse events (RR 0.83, 95% CI 0.60–1.16) did not differ significantly. Certainty of evidence was moderate for efficacy outcomes and low for mortality and safety outcomes.

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This systematic review and meta-analysis pooled 12 randomized controlled trials (2,429 patients; 1,202 MMAE, 1,227 control), including the 2026 EMMA-Can, G-MEMBRANE and MEMBRANE trials, to evaluate middle meningeal artery embolization (MMAE) for chronic subdural hematoma. Study-defined treatment failure occurred in 9.1% of patients with MMAE versus 18.3% with standard management (RR 0.52, 95% CI 0.39–0.69), corresponding to an absolute risk reduction of 8.8% and a number needed to treat of about 12. Reoperation or surgical rescue was also lower (4.4% vs 11.6%; RR 0.40, 95% CI 0.31–0.52). The benefit was consistent across surgery-only and mixed comparator subgroups (P for subgroup difference=0.317). All-cause mortality (RR 0.72, 95% CI 0.37–1.43) and severe adverse events (RR 0.83, 95% CI 0.60–1.16) did not differ significantly. Certainty of evidence was moderate for efficacy outcomes and low for mortality and safety outcomes.
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