Middle meningeal artery embolization with standalone or adjunctive coiling for treatment of chronic subdural hematoma: Systematic review and meta-analysis

Introduction Middle meningeal artery embolization (MMAe) is increasingly utilized as a primary or secondary treatment for chronic subdural hematoma (cSDH) and is usually performed with liquid embolics or particles. Outcomes after MMAe with coiling as a standalone treatment, or an adjunct to other agents, have not been reviewed. Methods A systematic review of the literature was performed to identify all original research that included patients who underwent standalone or adjunctive coiling for MMAe. The primary outcome was the need for rescue treatment defined as any unplanned reintervention for recurrent or residual cSDH. Results A total of 10 studies comprising 346 patients (mean age 73 years, 39% female) who underwent MMAe with coils were included. The majority of embolizations were with coils and particles ( n = 176), followed by standalone coiling (137) and coiling with liquid embolics (120). The pooled rate of rescue treatment after embolization was 9.4% (95% CI 6.4–13.6, I 2 = 0). The pooled complication rate was 2.6% (95% CI 1.3–5.1, I 2 = 0). In the subgroup analysis of four studies reporting results after standalone coiling, the pooled rescue treatment rate was 8.2% (95% CI 4.0–15.9, I 2 = 0) and there were no complications. Conclusion MMAe with coils is safe and potentially effective, but additional studies evaluating long-term clinical and radiographic results after standalone coiling are needed.