Risk of recurrence of subdural hematoma after EMMA vs surgical drainage – Systematic review and meta-analysis

Abstract

Objective Chronic subdural hematoma (CSDH) is a common and debilitating neurological condition whose treatments, including burr hole drainage and craniotomy, suffer from high rates of recurrence and complication. Embolization of the middle meningeal artery (EMMA) is a promising minimally invasive approach to manage CSDH in a broad set of patients. Methods To evaluate the efficacy and safety of EMMA, a database search was conducted including the terms “subdural hematoma; embolization; embolized; middle meningeal” was performed and yielded a total of 260 results. Following exclusion based on predefined criteria, a total of four studies were identified and outcomes including recurrence rates and complication rates were extracted for analysis. Results Four studies including intervention and control groups were included with a total of n = 888 patients. The relative risk of CSDH recurrence in the EMMA (3.5%) compared to control group (23.5%) was significantly reduced when EMMA was performed (risk ratio = 0.17; 95% confidence interval (CI) 0.05–0.67). In addition, rates of complication were not significantly different between patients with conventional therapy and those who received EMMA (OR = 0.77; 95 confidence interval (CI) 0.3–1.99). Conclusion Based on limited data, EMMA reduces the risk of recurrence by 20% compared to surgical treatment for CSDH.

Management of Chronic Subdural Hematoma: A Systematic Review and Component Network Meta-analysis of 455 Studies With 103 645 Cases

“…75 Multiple previous pairwise meta-analyses have demonstrated benefit compared with conventional treatment. 19,76,77 In our analysis, MMA embolization reduced recurrence by approximately 80%, suggesting effectiveness both alone and with surgery. Only a single pilot randomized trial has evaluated embolization, 53 but our analysis shows its benefit appears robust after accounting for the effects of specific surgical treatments.…”

Valve-controlled chronic subdural hematoma drainage: A feasibility study

“…Furthermore, a second burr hole does not improve the risk of recurrence (OR, 1.28; 0.92–1.78) ( Ding et al., 2020 ; Wan et al., 2019 ). On the contrary, the newly emerged middle meningeal artery embolization could be of value in reducing hematoma recurrence compared to conventional hematoma evacuation ( Srivatsan et al., 2019 ; Dian et al., 2021 ). This minimally invasive technique showed lower rates of recurrence (OR ​= ​0.087; 0.026–0.292; P ​< ​0.001) with comparable rates of complications (OR ​= ​0.563; 0.107–2.96; P ​= ​0.497) ( Srivatsan et al., 2019 ).…”

Endovascular Treatment of Chronic Subdural Hematomas through Embolization: A Pilot Study with a Non-Adhesive Liquid Embolic Agent of Minimal Viscosity (Squid)

“…In the Link et al (2019) series, 8.9% of the embolized patients needed additional surgery, while in 91.1%, the volume of the CSDH was stable or decreased, thus avoiding surgery [ 50 ]. A meta-analysis by Dian et al (2021) calculated a 20% reduced risk of CSDH recurrence after MMA embolization compared to surgical evacuation [ 61 ].…”