SYSTEMATIC REVIEW article
Front. Surg.
Sec. Neurosurgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1623619
This article is part of the Research TopicComprehensive Approaches to the Management of Chronic Subdural Hematoma: Integrating Surgical and Molecular InsightsView all articles
Adjunctive role of middle meningeal artery embolization in patients with surgical treatment of unilateral chronic subdural hematoma: A systematic review and meta-analysis of randomized controlled trials
Provisionally accepted
- 1Department for Neurosurgery, University Hospital Leipzig, Leipzig, Germany
- 2Leipzig University, leipzig, Germany
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Background: Chronic subdural hematoma (cSDH) is a common neurological condition, with high recurrence rates after surgical evacuation, posing significant challenges for patient outcomes. Middle meningeal artery embolization (MMAE) has emerged as a potential adjunctive therapy to reduce recurrence and reoperation rates. This meta-analysis evaluates the impact of MMAE on recurrence and reoperation rates in surgically treated unilateral subdural hematoma patients.A systematic review and meta-analysis were conducted, adhering to PRISMA guidelines. Randomized controlled trials comparing surgical evacuation with and without adjunctive MMAE were included. The primary outcomes were recurrence and reoperation rates within 90 days. Pooled odds ratios (ORs) were calculated using a random-effects model. Statistical heterogeneity was assessed using the I² statistic.Results: Two trials involving 965 patients met inclusion criteria. 478 patients underwent surgery with MMAE, and 487 patients underwent only surgery. MMAE reduced reoperation rates from 6.0% in controls to 2.5% in the MMAE group (OR: 0.41, 95% CI: 0.20-0.82; p = 0.01), with no significant heterogeneity (I² = 0%). Recurrence rates were lower in the MMAE group (5.2% vs. 9.2%, OR: 0.52, 95% CI: 0.17-1.59; p = 0.25), but the difference was not statistically significant.MMAE significantly reduces the risk of reoperation in surgically treated unilateral subdural hematoma patients and may also reduce recurrence rates. These findings support the integration of MMAE as an adjunct to surgery in selected patients.
Keywords: chronic subdural hematoma, Meta-analysis, middle meningeal artery embolization, Reoperation, Surgical evacuation, unilateral
Received: 06 May 2025; Accepted: 09 Jul 2025.
Copyright: © 2025 Wach, Vychopen and Güresir. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Johannes Wach, Department for Neurosurgery, University Hospital Leipzig, Leipzig, Germany
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