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Complications of Middle Meningeal Artery Embolization: A Systematic Review and Meta-Analysis
Mahnoor Shafi1, Shrikar R Badikol2, Jakob V E Gerstl3
1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Background:
Middle meningeal artery embolization (MMAE) is an established treatment option for chronic subdural hematoma. The aim of this systematic review and meta-analysis was to establish estimates of the pooled incidence for complications following MMAE.
Methods:
PubMed, Embase, and Cochrane were searched for studies reporting complications following MMAE through January 2023. A random effects model was used to calculate the pooled incidence of complications stratified based on whether studies excluded patients with comorbidities. Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed.
Results:
A final 34 studies containing 921 patients undergoing MMAE were included that reported 35 complications. Neurological complications were reported in 7 studies with an overall pooled incidence of 3.8% (95% confidence interval [CI]: 2.6%-5.5%). Across these studies, there was a pooled incidence of 4.9% (95% CI: 2.9%-8.0%), 3.0% (95% CI: 1.7%-5.3%), and 2.1% (95% CI: 0.4%-9.7%) in studies that did not exclude, did not mention, or excluded patients with comorbidities, respectively. Similarly, 7 studies reported cardiovascular complications with an overall pooled incidence of 3.6% (95% CI: 2.4%-5.4%), 4 studies reported infectious complications with an overall pooled incidence of 2.9% (95% CI: 1.9%-4.5%), and 3 studies reported for miscellaneous complications with an overall pooled incidence of 3.1% (95% CI: 2.0%-4.8%). Further subgroup analysis revealed the pooled incidence of cardiovascular complications was 3.2% (95% CI: 1.7%-6.1%) in studies that did not exclude patients with comorbidities, 4.1% (95% CI: 2.3%-7.1%) in studies that did not specify the exclusion of such patients, and 1.8% (95% CI: 0.2%-11.5%) in studies that excluded these patients. Similarly, the incidence of infectious complications was 3.3% (95% CI: 1.7%-6.2%), 2.7% (95% CI: 1.5%-5.0%), and 1.8% (95% CI: 0.2%-11.5%) across these groups, respectively. Miscellaneous complications were reported at 4.0% (95% CI: 2.2%-7.2%), 2.3% (95% CI: 1.1%-4.6%), and 3.1% (95% CI: 0.9%-10.1%), respectively.
Conclusions:
The published literature suggests that MMAE is a generally well-tolerated procedure with a low risk of significant complications.
Insights
Middle meningeal artery embolization (MMAE) is a safe procedure for chronic subdural hematoma, with a low incidence of complications. This systematic review found MMAE to be generally well-tolerated, indicating a low risk of adverse events.
Area of Science:
- Interventional Neurology
- Neurosurgery
- Vascular Surgery
Background:
- Middle meningeal artery embolization (MMAE) is a recognized treatment for chronic subdural hematoma.
- Understanding the complication rates associated with MMAE is crucial for patient management and procedural refinement.
Purpose of the Study:
- To systematically review and meta-analyze the incidence of complications following MMAE.
- To provide pooled estimates of complication rates in patients undergoing MMAE for chronic subdural hematoma.
Main Methods:
- A comprehensive search of PubMed, Embase, and Cochrane databases was conducted through January 2023.
- A random effects model was employed to calculate pooled complication incidence, with stratification based on comorbidity exclusion criteria.
- The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.
Main Results:
- Thirty-four studies including 921 patients reported 35 complications.
- The overall pooled incidence of neurological complications was 3.8% (95% CI: 2.6%-5.5%).
- Pooled incidences for cardiovascular, infectious, and miscellaneous complications were 3.6% (95% CI: 2.4%-5.4%), 2.9% (95% CI: 1.9%-4.5%), and 3.1% (95% CI: 2.0%-4.8%), respectively.
Conclusions:
- Middle meningeal artery embolization (MMAE) is generally well-tolerated.
- The procedure demonstrates a low risk of significant complications in the treatment of chronic subdural hematoma.
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