Abstract Details

Title Efficacy and Safety of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: An Updated Systematic Review and Meta-analysis Focusing on Time of Intervention

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-009

Objective To evaluate the efficacy and safety of MMAE plus standard therapy versus standard therapy alone, stratified by timing of intervention.

Background Chronic subdural hematoma (cSDH) is increasingly prevalent in the elderly due to aging and antithrombotic use. Burr-hole drainage remains the standard treatment, but recurrence rates are high. Middle meningeal artery embolization (MMAE) has emerged as an adjunctive strategy to disrupt dural neovascularization and prevent rebleeding.

Design/Methods RCTs were searched in PubMed, Embase, and Cochrane Central to July 2025. Eligible studies included adults with confirmed cSDH. Primary outcome: hematoma recurrence or persistence. Secondary outcomes: reoperation, hematoma resorption, serious adverse events, neurological death, mortality, and functional independence. Risk of bias was assessed with RoB-2, following PRISMA and Cochrane guidelines. Pooled analyses with 95% CIs were conducted using Review Manager 5.4. (PROSPERO CRD420251112841).

Results Seven RCTs (1,889 patients) were included. MMAE significantly reduced recurrent/residual cSDH (RR: 0.63; 95% CI: 0.46–0.85) and the need for reoperation (RR: 0.39; 95% CI: 0.28–0.56), without increasing serious adverse events (RR: 0.87; 95% CI: 0.72–1.06), neurological death, mortality, or poor functional outcomes. Hematoma volume resorption showed no significant difference. Sensitivity analyses confirmed robustness. Subgroup analyses showed consistent benefit for reducing reoperation across age groups, timing, follow-up periods, and bias categories, while recurrence, adverse events, and mortality were not significantly affected. Three studies were low risk of bias, two had some concerns, and two were high risk.

Conclusions

MMAE combined with standard therapy significantly reduces recurrence and reoperation in cSDH without increasing adverse events or mortality. Its benefit appears independent of procedure timing. Larger RCTs with longer follow-up are needed to define long-term impact and optimal use.

Authors/Disclosures
Gabriela D. Carolino PRESENTER	Miss Carolino has nothing to disclose.
ALUISIO D. GOMES, MS	Mr. GOMES has nothing to disclose.
Amanda Rabelo	Miss Rabelo has nothing to disclose.
Isabela L. Santos	Ms. Santos has nothing to disclose.
Carolina A. Corrêa, Medical Student	Ms. Corrêa has nothing to disclose.
Julia F. Oliveira, MD	Dr. Oliveira has nothing to disclose.
Tacio R. Batista	Dr. Batista has nothing to disclose.
Maria E. Valverde, Student	Miss Valverde has nothing to disclose.
Fernanda V. Alves, Medical Student	Ms. Alves has received personal compensation in the range of $0-$499 for serving as a Writing/text Correction with Professor Márcio Flávio. An immediate family member of Ms. Alves has received personal compensation in the range of $500-$4,999 for serving as a Management Assistant for Learning with Fundação Getúlio Vargas - FGV.
Igor Vinícius V. de Mello, Student	Mr. de Mello has nothing to disclose.
José Ricardo Vanzin, PhD	Mr. Vanzin has nothing to disclose.
Luciano Manzato, MD	Dr. Manzato has nothing to disclose.

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