Standalone middle meningeal artery embolization vs. surgical evacuation in chronic subdural hematoma: A comprehensive systematic review and meta-analysis
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Background Chronic subdural hematoma (cSDH) remains a prevalent neurosurgical condition in elderly patients, traditionally managed via surgical evacuation when symptomatic. Middle meningeal artery embolization (MMAE) has recently emerged as a minimally invasive alternative. However, the comparative efficacy and safety of standalone MMAE versus standalone surgical evacuation remain inadequately defined. Methods A comprehensive search of PubMed, Scopus, Embase, and Web of Science, was performed on March 20, 2025. Studies comparing standalone MMAE and standalone surgical evacuation in patients with cSDH were included. The primary outcome was recurrence; secondary outcomes included complication and mortality rates. A random-effects pairwise meta-analysis model using restricted maximum likelihood (REML) was applied to account for between-study variability. Results Ten studies encompassing 50,138 patients were included. Recurrence was significantly lower with MMAE (RR = 0.51, 95% CI: 0.33–0.80, p = .00), with no statistically detected heterogeneity (I 2 = 0%), although clinical variability across studies cannot be excluded. Mortality (RR = 0.70, 95% CI: 0.44–1.12, p = .14) and complications (RR = 1.04, 95% CI: 0.67–1.64, p = .85) did not differ significantly between both groups. The GRADE assessment rated the certainty of evidence for recurrence as moderate, while the certainty for both mortality and complications were rated as very low, underscoring the need for further high-quality studies. Conclusion Standalone MMAE significantly reduces recurrence risk compared to surgical evacuation in cSDH patients, while showing no significant difference in mortality or complication rates. These findings highlight MMAE as a promising first-line treatment option, particularly for patients at high surgical risk. Prospective randomized trials are warranted to further validate these outcomes.
Source: The Neuroradiology Journal
Authors: Ibrahim Mohammadzadeh, Bardia Hajikarimloo, Sai Sanikommu, Amirhossein Zare, Ali Mortezaei, Saba Aghajani, Ahmad Alagha, Misagh Iranpour, Mohammad Amin Habibi, Kivanc Yangi, Seyed Ali Mousavinejad, Farzan Fahim, Adam A Dmytriw, Redi Rahmani, Vratko Himic, Ricardo J Komotar, Khaled M Taghlabi, Amir H Faraji, Emade Jaman, Ahmed Abdelsalam, Ahmet Günkan, Peter Kan, Jason P Sheehan, Robert M Starke, Pascal Jabbour
Institutions: Shahid Beheshti University of Medical Sciences, University of Virginia, University of Miami, Tehran University of Medical Sciences, Gonabad University of Medical Sciences, Shariati Hospital, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Brigham and Women's Hospital, St. Michael's Hospital, Harvard University, University of Toronto, Massachusetts General Hospital, St Michael’s Hospital, University of Pennsylvania, Houston Methodist, University of Arizona, The University of Texas Medical Branch at Galveston, Thomas Jefferson University
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7135077935