A systematic review and Meta-Analysis of Middle meningeal artery embolization for Non-Acute Subdural Haematoma: A proposed treatment algorithm
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: OBJECTIVE: To synthesize the evidence from recent large randomized controlled trials (RCTs) on middle meningeal artery embolization (MMAE) for non-acute subdural haematoma (SDH) and to propose a unified, evidence-based treatment algorithm to guide clinical practice. METHODS: We conducted a systematic review and meta-analysis of large (n ≥ 100), multicentre RCTs comparing MMAE with surgical evacuation or conservative management for non-acute SDH. A comprehensive search of PubMed/MEDLINE, Embase, and CENTRAL was performed to August 2025. The primary outcome was treatment failure, a composite of radiological recurrence, symptomatic progression, or need for repeat surgery/surgical rescue at 90-180 days. Key secondary outcomes included functional status (modified Rankin Scale, mRS) and safety. Random-effects models were used for pooled analyses. RESULTS: Four RCTs involving 1,774 patients were included. For patients managed non-surgically, standalone MMAE was associated with a 64% relative risk reduction in treatment failure compared to conservative management (Risk Ratio [RR] 0.36, 95% CI [0.22, 0.60]). The number needed to treat was 4. As a surgical adjunct, MMAE offered a more modest but significant benefit in reducing recurrence or progression (RR 0.65, 95% CI [0.48, 0.89]). MMAE did not significantly improve functional outcomes or all-cause mortality but demonstrated a favourable safety profile with low rates of serious complications. CONCLUSIONS: MMAE significantly reduces treatment failure in non-acute SDH, with the most profound benefit seen in non-surgical patients by lowering the need for surgical rescue. Its role as a routine surgical adjunct is less clear, suggesting a stratified approach for patients at high risk of recurrence.
Source: Journal of Clinical Neuroscience
Authors: Jack Edward Liu, Christen D. Barras, Behnam Shaygi, Hong Kuan Kok, Davor Pavlin-Premrl, Lee-Anne Slater, Calvin Gan, Augusto Gonzalvo, Paul D. Smith, Jeremy Russell, Ashu Jhamb, Justin Moore, Julian Maingard, Andrew Gauden, Ali Khabaza, Ronil V. Chandra, Anousha Yazdabadi, Sean Stevens, Mark Brooks, Hamed Asadi
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,830
OpenAlex ID: W7128810542