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Research ArticleInterventional

Embolic Agent Choice in Middle Meningeal Artery Embolization as Primary or Adjunct Treatment for Chronic Subdural Hematoma: A Systematic Review and Meta-analysis

J.C. Ku, A.A. Dmytriw, M.A. Essibayi, M.A. Banihashemi, J.E. Vranic, S. Ghozy, D. Altschul, R.W. Regenhardt, C.J. Stapleton, V.X.D. Yang and A.B. Patel
American Journal of Neuroradiology March 2023, 44 (3) 297-302; DOI: https://doi.org/10.3174/ajnr.A7796
J.C. Ku
aFrom the Division of Neurosurgery (J.C.K.)
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A.A. Dmytriw
cNeuroendovascular Program (A.A.D., J.E.V., R.W.R., C.J.S., A.B.P.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
gNeurointerventional Program (A.A.D., V.X.D.Y.), Department of Clinical Neurological Sciences & Medical Imaging, Schulich School of Medicine, Western University, London, Ontario, Canada
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M.A. Essibayi
dDepartments of Radiology (M.A.E., S.G.), Mayo Clinic, Rochester, Minnesota
eDepartment of Neurosurgery (M.A.E., D.A.), Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York
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M.A. Banihashemi
bDepartment of Surgery and Institute of Medical Science (M.A.B.), University of Toronto, Toronto, Ontario, Canada
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J.E. Vranic
cNeuroendovascular Program (A.A.D., J.E.V., R.W.R., C.J.S., A.B.P.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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S. Ghozy
dDepartments of Radiology (M.A.E., S.G.), Mayo Clinic, Rochester, Minnesota
fNuffield Department of Primary Care Health Sciences and Department for Continuing Education (EBHC program) (S.G.), Oxford University, Oxford, UK
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D. Altschul
eDepartment of Neurosurgery (M.A.E., D.A.), Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York
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R.W. Regenhardt
cNeuroendovascular Program (A.A.D., J.E.V., R.W.R., C.J.S., A.B.P.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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C.J. Stapleton
cNeuroendovascular Program (A.A.D., J.E.V., R.W.R., C.J.S., A.B.P.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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V.X.D. Yang
gNeurointerventional Program (A.A.D., V.X.D.Y.), Department of Clinical Neurological Sciences & Medical Imaging, Schulich School of Medicine, Western University, London, Ontario, Canada
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A.B. Patel
cNeuroendovascular Program (A.A.D., J.E.V., R.W.R., C.J.S., A.B.P.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Abstract

BACKGROUND: Middle meningeal artery embolization is an emerging treatment option for chronic subdural hematomas.

PURPOSE: Our aim was to assess outcomes following middle meningeal artery embolization by different techniques, including in comparison with traditional surgical methods.

DATA SOURCES: We searched the literature databases from inception to March 2022.

DATA SELECTION: We selected studies reporting outcomes after middle meningeal artery embolization as a primary or adjunctive treatment for chronic subdural hematoma.

DATA ANALYSIS: We analyzed the risk of recurrence of chronic subdural hematoma, reoperation for recurrence or residual hematoma, complications, and radiologic and clinical outcomes using random effects modeling. Additional analyses were performed on the basis of whether middle meningeal artery embolization was used as the primary or adjunct treatment and by embolic agent type.

DATA SYNTHESIS: Twenty-two studies were included with 382 patients with middle meningeal artery embolization and 1373 surgical patients. The rate of subdural hematoma recurrence was 4.1%. Fifty (4.2%) patients underwent a reoperation for a recurrent or residual subdural hematoma. Thirty-six (2.6%) experienced postoperative complications. The rates of good radiologic and clinical outcomes were 83.1% and 73.3%, respectively. Middle meningeal artery embolization was significantly associated with decreased odds of subdural hematoma reoperation (OR = 0.48; 95% CI, 23.4–99.1; P = .047) compared with surgery. The lowest rates of subdural hematoma radiologic recurrence, reoperation, and complications were observed among patients receiving embolization with Onyx, whereas good overall clinical outcome occurred most commonly with combined polyvinyl alcohol and coils.

LIMITATIONS: A limitation was the retrospective design of studies included.

CONCLUSIONS: Middle meningeal artery embolization is safe and effective, either as a primary or adjunctive treatment. Treatment using Onyx seems to yield lower rates of recurrence, rescue operation, and complications whereas particles and coils produce good overall clinical outcomes.

ABBREVIATIONS:

cSDH
chronic subdural hematoma
MMA
middle meningeal artery
PVA
polyvinyl alcohol
SDH
subdural hematoma
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American Journal of Neuroradiology: 44 (3)
American Journal of Neuroradiology
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1 Mar 2023
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Embolic Agent Choice in Middle Meningeal Artery Embolization as Primary or Adjunct Treatment for Chronic Subdural Hematoma: A Systematic Review and Meta-analysis
J.C. Ku, A.A. Dmytriw, M.A. Essibayi, M.A. Banihashemi, J.E. Vranic, S. Ghozy, D. Altschul, R.W. Regenhardt, C.J. Stapleton, V.X.D. Yang, A.B. Patel
American Journal of Neuroradiology Mar 2023, 44 (3) 297-302; DOI: 10.3174/ajnr.A7796

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Embolic Agent Choice in Middle Meningeal Artery Embolization as Primary or Adjunct Treatment for Chronic Subdural Hematoma: A Systematic Review and Meta-analysis
J.C. Ku, A.A. Dmytriw, M.A. Essibayi, M.A. Banihashemi, J.E. Vranic, S. Ghozy, D. Altschul, R.W. Regenhardt, C.J. Stapleton, V.X.D. Yang, A.B. Patel
American Journal of Neuroradiology Mar 2023, 44 (3) 297-302; DOI: 10.3174/ajnr.A7796
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