Abstract Number: Esoc2026a917 Embolisation of Middle Meningeal Artery in Patients With Chronic Subdural Haematoma: A Systematic Review and Meta-Analysis of Randomized-Controlled Clinical Trials

Abstract Background and aims Chronic subdural haematoma (cSDH) is a common neurosurgical condition, particularly among elderly patients. Middle meningeal artery (MMA) embolisation has emerged as a minimally invasive adjunctive treatment aiming at reducing recurrence. However, its efficacy and safety remain under investigation. Methods We performed a systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) comparing MMA embolisation plus best medical therapy (BMT) with BMT alone in adults with symptomatic cSDH. The primary efficacy outcome was haematoma recurrence or progression at follow-up. Secondary efficacy outcomes included good functional outcome modified Rankin Scale (mRS) ≤ 2, independent ambulation (mRS ≤ 3), and haematoma thickness at follow-up. The primary safety outcome was all-cause mortality. Procedure-related complications were assessed as a secondary safety outcome. Results Nine RCTs were included, enrolling 2,452 patients (1,212 treated with MMA embolisation and 1,240 with BMT alone). MMA embolisation significantly reduced haematoma recurrence compared to BMT alone (RR: 0.48; 95%CI: 0.37–0.63; I2 = 26%; number-needed-to-treat = 11). No significant differences were observed for good functional outcome (RR: 1.02; 95%CI: 0.98–1.06; I2 = 0%), independent ambulation (RR: 1.01; 95%CI: 0.99–1.04; I2 = 0%), or haematoma thickness at follow-up (SMD: −0.1; 95%CI: −0.3 to 0; I2 = 42%). All-cause mortality was similar between the two groups (RR: 1.03; 95%CI: 0.54–1.96; I2 = 37%). The pooled rate of procedure-related complications in the MMA embolisation group was 1% (95%CI: 0–3%; I2 = 52%). Conclusions Adjunctive MMA embolisation significantly lowers cSDH recurrence but does not confer measurable benefits in functional outcomes or mortality. Further studies should define patient subgroups that benefit most from MMA embolisation. Conflict of interest Nothing to disclose.