The Role of Middle Meningeal Artery Embolisation in the Management of Refractory Chronic Subdural Haematoma: A Systematic Review of Randomised Controlled Trials and Primary Studies

Vollständiger Abstract

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Introduction. Chronic subdural haematoma (cSDH) is among the most frequent conditions encountered in contemporary neurosurgical practice and is projected to become the commonest cranial operative indication in ageing populations. Conventional surgical evacuation relieves mass effect but does not address the pathophysiological substrate of the disease—an inflammatory, angiogenic and hyperfibrinolytic neomembrane perfused by fragile, leaky branches of the middle meningeal artery (MMA). Consequently, recurrence rates of 2–37% persist after apparently adequate evacuation. Middle meningeal artery embolisation (MMAE) is a minimally invasive endovascular technique that devascularises the neomembrane and, in principle, interrupts the recurrence cycle at its source. Methods. The study strictly adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. Eligible: RCTs, prospective and retrospective cohorts, case-control, cross-sectional, and observational studies; systematic reviews excluded from characteristics tables. Risk of bias assessed with RoB 2 and ROBINS-I; certainty with GRADE. Results. Forty primary reports (10 RCTs, 2,552 participants; 30 non-RCT studies, 204,509 patients). Adjunctive or standalone MMAE halved symptomatic recurrence (RR 0.51; 95%CI 0.38–0.68; 9 RCTs; P