Efficacy and safety of middle meningeal artery embolisation for chronic subdural haematoma: a systematic review and meta-analysis of randomised controlled trials.
Jolie Jin En Wong, Mohammed Jameel, Rocío Pérez et al.
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In 30 seconds
This PRISMA-compliant systematic review and meta-analysis pooled randomised controlled trials comparing middle meningeal artery embolisation (MMAE)-based treatment with standard management in adults with radiologically confirmed chronic subdural haematoma. Across 12 trials involving 2,429 participants, treatment failure occurred in 9.1% with MMAE and 18.3% with control; the pooled risk ratio was 0.52 (95% CI 0.39-0.69). MMAE also reduced reoperation or surgical rescue. All-cause mortality and severe adverse events did not differ significantly. Certainty was moderate for treatment failure and reoperation, and low for mortality and severe adverse events.
Key findings
- Treatment failure was 9.1% with MMAE versus 18.3% with standard management (RR 0.52, 95% CI 0.39-0.69).
- Reoperation or surgical rescue was reduced with MMAE (RR 0.40, 95% CI 0.31-0.52).
- All-cause mortality (RR 0.72, 95% CI 0.37-1.43) and severe adverse events (RR 0.83, 95% CI 0.60-1.16) did not differ significantly.
Why it matters
Treatment failure and repeat intervention are important outcomes in chronic subdural haematoma management. This synthesis of randomised evidence suggests MMAE-based treatment can reduce both, while the available trials did not establish a significant difference in mortality or severe adverse events. The findings help clarify potential benefits but leave uncertainty about the intervention’s optimal role and safety outcomes.
What to keep in mind
Certainty was low for mortality and severe adverse events. The authors call for further well-powered randomised trials with standardised efficacy and safety outcomes.