Middle Meningeal Artery Embolization in the Treatment of Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
INTRODUCTION: There is increasing evidence that middle meningeal artery embolization (MMAE) can be used to treat chronic subdural hematoma (cSDH). The purpose of this study was to demonstrate the efficacy and safety of MMAE treatment through a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs). METHODS: We searched the PubMed, Embase, Cochrane Library, and Web of Science databases to obtain articles related to MMAE from inception to December 3, 2024. The effectiveness outcomes were recurrence, progression, or reoperation of subdural hematoma after treatment, 90-day mRS 0-2, and 90-day mRS 0-3. The safety outcomes were severe deterioration of neurologic function and death within 180 days. The quality of the RCTs was evaluated with the Cochrane risk assessment tool, while the cohort studies were evaluated by the Newcastle-Ottawa Scale (NOS). The random-effect model was used to calculate the effect as risk ratio (RR). The heterogeneity of the results of each study was analyzed by χ2 test. RESULTS: A total of 892 articles are retrieved. Among those, 4 RCTs and 5 cohort studies met the inclusion criteria. The RCT analysis showed that MMAE plus traditional treatment reduced the risk of recurrence or progression of hematoma compared with traditional treatment alone (5.3% vs. 9.1%; RR: 0.58, 95% CI, 0.39-0.86, p = 0.03). The heterogeneity was very low (I2 = 22%). There was no significant difference between the two groups for the 90-day mRS 0-2 and 0-3 scores (p = 0.73/p = 0.71, respectively). In terms of safety outcomes, the 180-day mortality was 3.5% in the MMAE plus traditional treatment group and 5.0% in the traditional treatment group (p = 0.49 > 0.05). Neurological deterioration was present in 4.6% of patients with MMAE plus traditional treatment compared to 3.9% with traditional treatment (p = 0.44 > 0.05). Across the 5 cohort studies, similar results were obtained for the incidence of recurrence, progression or reoperation of subdural hematoma (12.9% vs. 40.6%; RR: 0.26, 95% CI, 0.07-0.95, p = 0.04), but the heterogeneity was very high (I2 = 89%). CONCLUSION: This systematic review and meta-analysis showed that in cSDH patients, MMAE was associated with a reduced rate of recurrence, progression or reoperation of the subdural hematoma compared to traditional treatment with surgery without increasing the incidence of death or adverse events.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.028 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.028 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".