Background: Large randomized controlled trials (RCTs) have yielded mixed results regarding the efficacy of adjunctive middle meningeal artery (MMA) embolization in reducing the risk of recurrence or progression of hematoma in patients with subacute or chronic subdural hematoma (CSDH). Therefore, we conducted a meta-analysis to evaluate the clinical utility of adjunctive MMA embolization in the management of CSDH. Methods: A systematic review and meta-analysis were performed by searching PubMed and the Cochrane Library for RCTs comparing adjunctive MMA embolization plus standard of care versus standard of care alone in patients with symptomatic CSDH. The primary composite outcome was hematoma recurrence, progression, or persistence. Secondary outcomes included short-term mortality (within 90 days) and serious adverse events (SAEs) within 3 months. A random-effects model was used for outcomes with significant heterogeneity, assessed using the I 2 statistic. Results: Four RCTs comprising 1,774 patients were included, of whom 877 received adjunctive MMA embolization. Within 90 days, there were no statistically significant differences in mortality (risk ratio RR 0.89; 95% confidence interval CI 0.41–1.95; p is equal to 0.77; I 2 is equal to 29%) or serious adverse events (RR 0.83; 95% CI 0.58–1.19; p is equal to 0.31; I 2 is equal to 52%). However, adjunctive MMA embolization was associated with a significantly lower risk of hematoma recurrence or progression compared to standard care (RR 0.55; 95% CI 0.40–0.74; p is less than 0.0001; I 2 is equal to 26%). Heterogeneity ranged from minimal to moderate across analyses. Conclusion: Adjunctive MMA embolization did not significantly reduce short-term mortality or serious adverse events compared to standard care in patients with CSDH. However, it was associated with a substantially lower risk of hematoma recurrence or progression. Further high-quality RCTs are warranted to evaluate the long-term benefits and safety of this intervention. These findings should be interpreted with caution due to heterogeneity among studies.
Nguyen et al. (2026) studied this question.