Middle meningeal artery embolization versus standard of care for chronic subdural hematoma: Meta-analysis of randomized controlled trials
Bibliographic record
Abstract
Background The safety and efficacy of the middle meningeal artery embolization (MMAE) in patients with non-acute or chronic subdural hematoma (cSDH) has significant reporting within recent literature, however, mainly in the form of observational data. Methods We conducted a systematic review and meta-analysis including all available randomized clinical trials (RCTs) that compared MMAE in addition to standard of care (SOC) versus SOC alone for cSDH. The primary outcome was the rate of recurrence and reoperation. Secondary outcomes included serious adverse events (SAEs), mortality rate, independent ambulation (modified Rankin Scale (mRS) score 0 – 3), and changes in hematoma characteristics at 90 days. The fixed-effect or random-effects model was used based on the significancy of the heterogenicity (I 2 > 50%, P < .1). Results Findings showed significant superiority of MMAE over SOC in 90-day recurrence (RR = 0.55, 95% CI = 0.36 – 0.83, P = .0047, I 2 = 43.3%), reoperation within 180 days (RR = 0.38, 95% CI = 0.26–0.56, P < .001, I 2 = 0.0%), ambulatory functional outcome (RR = 1.034, 95% CI = 1.0–1.07, P = .0296, I 2 = 53.9%), SAE at any time (RR = 0.59, 95% CI = 0.38–0.94, P = .025, , I 2 = 0.0%), and 90-day any-cause mortality (RR = 0.29, 95% CI = 0.14–0.6, P = .0008, I 2 = 0.0%). Successful embolization and 30-day embolization-related complications occurred in 99.2% (95% CI = 94.54% – 100%) and 1.18% (95% CI = 0.39% – 2.31%) of patients, respectively. Additionally, subgroup analyses on major and pilot RCTs, comparison of embolic agents, and MMAE adjuvant to surgery versus surgery alone confirmed these findings. Conclusion MMAE appears to be safe and effective in the management of cSDH with low recurrence and SAE rate.
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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 | 0.016 | 0.032 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.037 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| 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".