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Review
Middle meningeal artery embolization for chronic subdural hematoma: a systematic review and meta-analysis
  1. Natasha Ironside1,
  2. Candice Nguyen2,
  3. Quan Do3,
  4. Beatrice Ugiliweneza2,
  5. Ching-Jen Chen1,
  6. Emily P Sieg2,
  7. Robert F James4,
  8. Dale Ding2
  1. 1Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
  2. 2Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
  3. 3Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
  4. 4Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
  1. Correspondence to Dr Dale Ding, Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY 40202, USA; daleding1234{at}gmail.com

Abstract

Middle meningeal artery (MMA) embolization has been proposed as a minimally invasive treatment for chronic subdural hematoma (cSDH). The aim of this systematic review and meta-analysis is to compare outcomes after MMA embolization versus conventional management for cSDH. We performed a systematic review of PubMed, Embase, Oxford Journal, Cochrane, and Google Scholar databases from April 1987 to October 2020 in accordance with PRISMA guidelines. Studies reporting outcomes after MMA embolization for ≥3 patients with cSDH were included. A meta-analysis comparing MMA embolization with conventional management was performed. The analysis comprised 20 studies with 1416 patients, including 718 and 698 patients in the MMA embolization and conventional management cohorts, respectively. The pooled recurrence, surgical rescue, and in-hospital complication rates in the MMA embolization cohort were 4.8% (95% CI 3.2% to 6.5%), 4.4% (2.8% to 5.9%), and 1.7% (0.8% to 2.6%), respectively. The pooled recurrence, surgical rescue, and in-hospital complication rates in the conventional management cohort were 21.5% (0.6% to 42.4%), 16.4% (5.9% to 27.0%), and 4.9% (2.8% to 7.1%), respectively. Compared with conservative management, MMA embolization was associated with lower rates of cSDH recurrence (OR=0.15 (95% CI 0.03 to 0.75), p=0.02) and surgical rescue (OR=0.21 (0.07 to 0.58), p=0.003). In-hospital complication rates were comparable between the two cohorts (OR=0.78 (0.34 to 1.76), p=0.55). MMA embolization is a promising minimally invasive therapy that may reduce the need for surgical intervention in appropriately selected patients with cSDH. Additional prospective studies are warranted to determine the long-term durability of MMA embolization, refine eligibility criteria, and establish this endovascular approach as a viable definitive treatment for cSDH.

  • subdural
  • angiography
  • hemorrhage

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Footnotes

  • Contributors NI performed the statistical analysis, drafted the initial manuscript, and revised the manuscript. CN performed the literature review, drafted the initial manuscript, and revised the manuscript. QD performed the literature review and statistical analysis. C-JC performed the statistical analysis and revised the manuscript. BU performed the statistical analysis. EPS and RFJ revised the manuscript. DD supervised the literature view and statistical analysis and revised the manuscript. He is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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