Comparative outcomes of middle meningeal artery embolization, burr hole drainage, and neuroendoscopic-assisted evacuation with MMA disconnection for chronic subdural haematoma: a multicenter retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objective To compare the efficacy, safety, and resource utilization of middle meningeal artery embolization (MMAE), burr hole drainage (BHD), and neuroendoscopic-assisted evacuation with middle meningeal artery disconnection (NE-MMAD) for chronic subdural haematoma (CSDH). Methods A retrospective analysis was performed on 265 patients with CSDH, divided into MMAE ( n = 46), BHD ( n = 152), and NE-MMAD ( n = 67) groups. The primary outcome was the 6-month recurrence rate. Secondary outcomes included neurological improvement rate, reoperation rate, operation time, hospital stay, number of imaging follow-ups, and complications. Results The recurrence rates for MMAE and NE-MMAD (4.35 and 4.48%, respectively) were significantly lower than that for BHD (19.74%, p = 0.001). The neurological improvement rate was highest in the NE-MMAD group (88.06%, p = 0.003). The reoperation rates for MMAE and NE-MMAD were both lower than that for BHD ( p = 0.002). In the MMAE group, 5 patients (10.87%) underwent salvage BHD due to delayed resolution of mass effect. MMAE had the shortest operation time (31 min) and hospital stay (7 days), while NE-MMAD had the longest operation time (70 min); both MMAE and NE-MMAD required fewer imaging follow-ups than BHD (all p < 0.05). No significant difference in complication rates was observed among the three groups; however, one patient in the MMAE group experienced permanent blindness due to inadvertent embolization through a dangerous anastomosis. Conclusion In this cohort, MMAE and NE-MMAD were associated with lower recurrence compared with BHD, and NE-MMAD was associated with the greatest neurological improvement. BHD may be preferred for first-onset, non-septated haematomas; MMAE may be preferred for older patients or those with coagulopathy, but the risk of blindness warrants caution; NE-MMAD may be preferred for septated, organized, recurrent, and markedly space-occupying haematomas. Clinical decision-making should integrate haematoma characteristics, patient status, and available medical resources to guide individualized stratified treatment.
Source: Frontiers in Neurology
Authors: Xudong Song, Yuan Zhang, Bo Luo, Xiyuan Tang
Institutions: Capital Medical University, Beijing Anzhen Hospital
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7222969297