Abstract Details

Title Adjunct Middle Meningeal Artery Embolization Chronic Subdural Hematoma: a Meta-analysis to Guide Surgical Decision Making

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S20 - Innovations in Cerebrovascular Therapy (3:54 PM-4:06 PM)

Poster/Presentation
Number 003

Objective To compare the efficacy and safety of middle meningeal artery embolization (MMAE) as a standalone therapy or adjunct to surgery versus conventional surgery for chronic subdural hematoma (cSDH).

Background Chronic subdural hematoma (cSDH) is a common neurosurgical condition in older adults. Burr-hole drainage remains standard, but recurrence rates of 9–33% highlight the need for better strategies. Middle meningeal artery embolization (MMAE) has emerged to reduce recurrence. This study evaluates safety, feasibility, and efficacy of MMAE as standalone or adjunctive treatment to guide practice and guidelines.

Design/Methods

We searched PubMed, MEDLINE, and EMBASE through June 2025. Randomized and observational studies in adults with cSDH reporting outcomes were eligible. Random-effects meta-analyses pooled RR or MD with 95% CIs; heterogeneity used I². Subgroups examined intervention type, design, hematoma thickness; sensitivity and meta-regression were performed.

Results Eighteen studies (n=25,663; 2,468 MMAE; 23,195 surgery) met criteria. Primary outcome was recurrence of cSDH. MMAE significantly reduced recurrence compared to surgery (RR 0.37, 95% CI 0.27–0.51; I² 50.5%; p<0.001). Benefit was seen with adjunct MMAE (RR 0.29, 95% CI 0.22-0.39; I² 0%) and standalone MMAE (RR 0.33, 95% CI 0.12-0.91; I² 60.7%); no subgroup difference (p=0.74). Across hematoma thickness <20 mm and ≥20 mm, effects were directionally consistent without significant interaction (p=0.147). Secondary outcome was mortality which did not differ between groups (RR 0.76, 95% CI 0.36-1.60). Complications were similar (RR 1.15, 95% CI 0.70-1.88). Length of stay showed a nonsignificant increase with MMAE (MD +2.88 days, 95% CI -1.68 to +7.44). Overall certainty ranged from low to moderate.

Conclusions

This meta-analysis of 25,000+ patients, including recent randomized trials through 2025, provides strong evidence that MMAE, adjunctive or standalone, significantly reduces cSDH recurrence without increasing mortality or complications. Comparing both strategies and stratifying by hematoma thickness shows consistent benefit, establishing MMAE as a paradigm-shifting, minimally invasive therapy.

Authors/Disclosures
Dhyey Sidhpura, MD PRESENTER	Dr. Sidhpura has nothing to disclose.
Adeena Musheer, MBBS	Dr. Musheer has nothing to disclose.
Mayesha Ahmed, DO	Dr. Ahmed has nothing to disclose.
Sana Said, MBBS	Miss Said has nothing to disclose.
Ayesha Arshad, MBBS	Ms. Arshad has nothing to disclose.
Areeb Amjad, MBBS	Dr. Amjad has nothing to disclose.
Huzaifa S. Nawaz, MBBS	Dr. Nawaz has nothing to disclose.
Muhammad Abbas, MBBS	Dr. Abbas has nothing to disclose.
Aziz Ur Rehman, MBBS	Mr. Rehman has nothing to disclose.
Tehseen Haider, MBBS	Dr. Haider has nothing to disclose.
Hafiz Sohail Ashraf, MD	Dr. Ashraf has nothing to disclose.

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