Related Experiment Video
Updated: Aug 11, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Middle Meningeal Artery Embolization with Liquid Embolic Agents for Chronic Subdural Hematoma: A Systematic Review
Ashkan Mowla1, Saeed Abdollahifard2, Amirmohammad Farrokhi2
1Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, California.
Purpose:
To assess the efficacy and safety of middle meningeal artery (MMA) embolization with liquid embolic agents and the outcomes of patients following this procedure.
Materials And Methods:
A review of the literature was conducted to identify studies investigating the efficacy and safety of MMA embolization with liquid embolic agents in patients with chronic subdural hematoma (cSDH) in PubMed, Scopus, Embase, and Web of Science. The keywords "liquid embolic agent," "middle meningeal artery," "cSDH," and "embolization" as well as their synonyms were used to build up the search strategy. The R statistical software and random-effects model were used for analysis. Heterogeneity was reported as I2, and publication bias was calculated using the Egger test.
Results:
Of 628 articles retrieved, 14 studies were eligible to be included in this study. Data of 276 patients were analyzed. n-Butyl cyanoacrylate and ethylene vinyl alcohol copolymer were the most commonly used embolic agents. This study revealed a pooled mortality rate of 0% (95% confidence interval [CI], 0.00%-100%), recurrence and failure rate of 3% (95% CI, 1%-10%), reoperation/reintervention rate of 4% (95% CI, 2%-12%), rate of size decrease of 94% (95% CI, 79%-98%), technical success rate of 100% (95% CI, 76%-100%), and adverse event rate of 1% (95% CI, 0.00%-4%).
Conclusions:
With low mortality, recurrence, reoperation, and adverse event rates and a remarkable decrease in the size of hematomas, MMA embolization with liquid embolic agents may be considered a safe and effective treatment option in patients in whom surgical intervention has previously failed and as an alternative to conventional treatments.
Insights
Middle meningeal artery (MMA) embolization using liquid embolic agents is a safe and effective treatment for chronic subdural hematoma (cSDH). This procedure shows low rates of recurrence, reoperation, and adverse events, making it a viable alternative to conventional therapies.
Area of Science:
- Interventional Neuroradiology
- Neurosurgery
- Vascular Surgery
Background:
- Chronic subdural hematoma (cSDH) presents a significant clinical challenge, often requiring invasive treatments.
- Middle meningeal artery (MMA) embolization has emerged as a promising minimally invasive therapeutic option.
- Liquid embolic agents offer precise delivery for MMA embolization.
Approach:
- A comprehensive literature review was performed across major databases (PubMed, Scopus, Embase, Web of Science).
- Studies investigating MMA embolization with liquid agents for cSDH were identified using specific keywords.
- Data from 14 eligible studies, encompassing 276 patients, were analyzed using a random-effects model.
Key Points:
- Pooled analysis revealed a 0% mortality rate and a 3% recurrence/failure rate.
- The procedure demonstrated a 94% rate of hematoma size decrease and a 100% technical success rate.
- Adverse events were infrequent, with a pooled rate of 1% and a 4% reoperation/reintervention rate.
Conclusions:
- MMA embolization with liquid embolic agents is a safe and effective treatment for cSDH.
- It offers a favorable alternative for patients with treatment failure or those seeking non-surgical options.
- The procedure is associated with low complication rates and high efficacy in reducing hematoma size.
Related Concept Videos
01:17Hemorrhagic Stroke l: Introduction
01:29Hemorrhagic Stroke ll: Pathophysiology
01:22Cerebral Edema ll: Pathophysiology