Adjunctive middle meningeal artery embolization after surgical evacuation of chronic subdural hematoma: An updated meta-analysis of randomized controlled trials

Authors

• Tallal M. Hashmi, Rawalpindi Medical University
• Hafsa Arshad Azam Raja, Rawalpindi Medical University
• Zain Tariq, St. Vincent Mercy Medical Center
• Faizan Ahmed, Jersey Shore University Medical Center
• Niraj Arora
• Majid T. Aized
• Adeel Saleemi
• Ameer E. Hassan, Valley Baptist Medical Center, The University of Texas Rio Grande ValleyFollow
• Adnan Qureshi, University of Missouri
• Osama O. Zaidat

Document Type

Article

Publication Date

10-1-2026

Abstract

Background: Middle meningeal artery embolization (MMAE) has emerged as a promising adjunctive treatment for chronic subdural hematoma (cSDH); however, the efficacy and safety of adjunctive MMAE compared with surgery alone remains uncertain.

Methods: We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception through June 2026. Randomized controlled trials comparing adjunctive MMAE plus surgical evacuation with surgical evacuation alone in patients with cSDH were included. The primary outcome was hematoma recurrence. Pooled odds ratios (ORs) with 95% CIs were calculated using a random-effects model.

Results: A total of eight randomized controlled trials were included. The mean age of participants ranged from 64 to 77 years, and most participants were male. Adjunctive MMAE was associated with significantly lower odds of recurrence compared with surgery alone (OR, 0.31 [95% CI, 0.16-0.59]). No significant differences were observed in all-cause mortality (OR, 0.91 [95% CI, 0.24-3.42]), good functional outcome (OR, 1.23 [95% CI, 0.23-6.42]), or overall adverse events (OR, 1.02 [95% CI, 0.35-2.91]) between the groups.

Conclusions: In this updated meta-analysis of randomized controlled trials, adjunctive MMAE significantly reduced recurrence without increasing complication rates. Although no significant improvements were observed in functional outcomes or mortality, these findings support adjunctive MMAE as an effective and safe strategy for improving disease control in patients undergoing surgical treatment for cSDH.

Comments

Copyright © 2026. Published by Elsevier Inc.http://creativecommons.org/licenses/by-nc-nd/4.0/

Recommended Citation

Hashmi, M. T. M., Raja, M. H. A. A., Tariq, M. Z., Ahmed, M. F., Arora, M. N., Aized, M. M. T., ... & Zaidat, M. O. O. (2026). Adjunctive Middle Meningeal Artery Embolization After Surgical Evacuation of Chronic Subdural Hematoma: An Updated Meta-analysis of Randomized Controlled Trials. Journal of Stroke and Cerebrovascular Diseases, 108729. https://doi.org/10.1016/j.jstrokecerebrovasdis.2026.108729

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.

Publication Title

Journal of Stroke and Cerebrovascular Diseases

DOI

10.1016/j.jstrokecerebrovasdis.2026.108729

Academic Level

faculty

Mentor/PI Department

Neurology