Background: Chronic subdural hematoma (cSDH) is a common neurosurgical condition with high recurrence rates, particularly in elderly patients. The pathophysiology involves complex mechanisms of angiogenesis, fibrinolysis, and inflammation, leading to progressive hemorrhage and fluid accumulation.
Aim: To systematically review and meta-analyze the clinical benefits and safety of middle meningeal artery embolization (MMAE) as an adjunctive treatment to usual care for cSDH.
Methods: A comprehensive literature search was conducted across four electronic databases following PRISMA guidelines. Four clinical trials were included, involving 1680 patients with cSDH. Meta-analysis was performed using the Mantel-Haenszel method to calculate risk ratios and 95 % confidence intervals for key outcomes, including recurrence, mortality, functional outcomes, and complications.
Results: MMAE plus usual care significantly reduced cSDH recurrence (Risk Ratio 0.56, 95 % CI [0.39 to 0.80], P = 0.001) and mortality (Risk Ratio [RR] 0.53, 95 % CI [0.31 to 0.91], P = 0.02) compared to usual care alone. No statistically significant differences were observed in functional outcomes (mRS 0-2 at 90 days), serious adverse events, or major disabling stroke between the two groups.
Conclusion: MMAE as an adjunctive treatment shows promising results in reducing cSDH recurrence and mortality without increasing procedural risks, suggesting potential benefits in managing this challenging neurosurgical condition.
Keywords: Middle meningeal artery embolization; Subdural hematoma; meta-analysis.
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