Middle meningeal artery embolization for chronic subdural hematoma: a systematic review

Abstract

BackgroundChronic subdural hematoma (cSDH) is one of the most common diseases in neurosurgery. Middle meningeal artery embolization (MMAE) is reportedly an option to prevent recurrence or avoid surgery in patients with cSDH. This study was performed to review the evidence on MMAE for cSDH and evaluate its safety, efficacy, indications, and feasibility.MethodsWe systematically reviewed the literature according to the PRISMA guidelines using an electronic database. The search yielded 43 articles involving 2,783 patients who underwent MMAE.ResultsThe hematoma resolution, recurrence, and retreatment rates in the MMAE-alone treatment group (n = 815) were 86.7%, 6.3%, and 9.6%, respectively, whereas those in the prophylactic MMAE with combined surgery group (n = 370) were 95.6%, 4.4%, and 3.4%, respectively. The overall MMAE-related complication rate was 2.3%.ConclusionThis study shows that MMAE alone is, although not immediate, as effective as evacuation surgery alone in reducing hematoma. The study also shows that combined treatment has a lower recurrence rate than evacuation surgery alone. Because MMAE is a safe procedure, it should be considered for patients with cSDH, especially those with a high risk of recurrence.

Therapeutic efficacy of drilling drainage combined with intraoperative middle meningeal artery occlusion in the management of chronic subdural hematoma: a clinical study

“…A systematic review reported that the recurrence rate of combined treatment is lower than that of evacuation surgery alone. The study also showed that combined treatment has a lower recurrence rate compared with that of evacuation surgery alone [39]. Additionally, the most prominent problem with simple MMA embolization is that the median time for hematoma regression after surgery is 5 months [40], which contradicts the original intention of patients who seek medical treatment for urgent relief of symptoms.…”

“…Patients desire prompt recovery and relief from the pain of the disease. Additionally, embolization is associated with complications [39,42], If interventional surgery can be avoided, minimally invasive drilling surgery utilizing a hole in the cranium with a diameter of several millimeters to occlude the MMA presents a viable option. This approach not only removes the angiogenic factors involved in the pathogenesis of the disease but also facilitates the discharge of the hematoma and inflammatory stimulating factors.…”

ARISE I Consensus Statement on the Management of Chronic Subdural Hematoma

“…Overall, MMAE procedures have a good safety profile, with an overall complication rate of ≈3% in the current literature. 72 The risks for stroke, hemorrhage, and visual loss are below 1% individually. 39 Thus, comparative safety profiles of embolic agents are hard to quantify and compare, and their elucidation requires larger prospective studies.…”