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Published on: October 20, 2017
Middle meningeal artery embolization for chronic subdural hematoma: a systematic review
Yoshihiro Omura1, Taichi Ishiguro1
1Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Chiba, Japan.
Insights
Middle meningeal artery embolization (MMAE) is effective for chronic subdural hematoma (cSDH), offering comparable resolution to surgery alone and lower recurrence when combined with surgery. MMAE is a safe option for cSDH patients.
Area of Science:
- Neurosurgery
- Interventional Radiology
Background:
- Chronic subdural hematoma (cSDH) is a prevalent neurosurgical condition.
- Middle meningeal artery embolization (MMAE) is an emerging treatment to prevent cSDH recurrence and potentially avoid surgery.
Approach:
- A systematic literature review adhering to PRISMA guidelines was conducted.
- 43 articles encompassing 2,783 patients who underwent MMAE were analyzed.
Key Points:
- MMAE alone achieved an 86.7% hematoma resolution rate with a 6.3% recurrence rate.
- Prophylactic MMAE combined with surgery showed a 95.6% resolution rate and a 4.4% recurrence rate.
- The overall complication rate associated with MMAE was low at 2.3%.
Conclusions:
- MMAE alone demonstrates comparable efficacy to surgical evacuation for hematoma resolution in cSDH.
- Combined MMAE and surgery significantly reduces recurrence rates compared to surgery alone.
- MMAE is a safe and viable treatment option for cSDH, particularly for high-risk patients.
Background:
Chronic 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.
Methods:
We 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.
Results:
The 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%.
Conclusion:
This 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.
