Middle meningeal artery embolization (MMAE) is a novel treatment for chronic subdural hematomas (cSDHs) with high variability of use across practitioners and institutions. This study sought to investigate whether standalone MMAE may be an effective alternative to combined MMAE and surgery for select patients with cSDH.

The authors searched the Medline and Embase databases for studies reporting outcomes specific to standalone MMAE and combined MMAE and surgery. The Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool was used to assess risk of bias in each included study. Patient characteristics were compared between cohorts, and rates of surgical recurrence of standalone MMAE and combined MMAE and surgery were pooled using random-effects models.

Four hundred two unique patients (156 with standalone MMAE and 246 with combined MMAE and surgery) were identified across 8 studies. Overall, the subdural thickness for the standalone MMAE group was modestly but statistically significantly smaller (16.8 vs 18.8 mm, estimated p value 0.002), and the mean follow-up time was significantly longer for the standalone MMAE group (5.4 vs 2.3 months, estimated p value < 0.001); there were no significant differences between age, sex, and anticoagulant use. The surgical recurrence rates were not significantly different between the two groups (estimated p value 0.63). Using random-effects models, the surgical recurrence rates were estimated at 6.8% (95% CI 3.5%–11.2%) and 4.6% (95% CI 2.3%–7.7%) for standalone MMAE and combined MMAE and surgery, respectively.

Standalone MMAE for cSDH may yield a low rate of surgical recurrence, which may be comparable to that of combined MMAE and surgery. However, studies in this systematic review and meta-analysis were primarily single-arm studies prone to treatment bias. Future studies are needed to further investigate whether standalone MMAE may be an effective alternative to combined MMAE and surgical treatment for cSDH in select patients.

脑膜中动脉栓塞（MMAE）是一种治疗慢性硬膜下血肿（cSDH）的新型治疗方法，在不同的从业者和机构中使用情况存在很大差异。本研究旨在探讨对于特定的 cSDH 患者，独立 MMAE 是否可以作为 MMAE 和手术联合治疗的有效替代方案。

作者检索了 Medline 和 Embase 数据库，寻找报告特定于独立 MMAE 以及 MMAE 与手术相结合的结果的研究。非随机干预研究中的偏倚风险 (ROBINS-I) 工具用于评估每项纳入研究的偏倚风险。对队列之间的患者特征进行比较，并使用随机效应模型汇总单独 MMAE 和组合 MMAE 与手术的手术复发率。

8 项研究中确定了 402 名独特患者（156 名患有独立 MMAE 的患者，246 名患有合并 MMAE 和手术的患者）。总体而言，独立 MMAE 组的硬膜下厚度适度，但在统计学上显着较小（16.8 与 18.8 毫米，估计 p 值 0.002），并且独立 MMAE 组的平均随访时间显着更长（5.4 个月与 2.3 个月，估计p 值 < 0.001)；年龄、性别和抗凝剂使用之间没有显着差异。两组之间的手术复发率没有显着差异（估计p值0.63）。使用随机效应模型，单独 MMAE 和 MMAE 联合手术的手术复发率估计分别为 6.8%（95% CI 3.5%–11.2%）和 4.6%（95% CI 2.3%–7.7%）。

单独 MMAE 治疗 cSDH 的手术复发率可能较低，与 MMAE 和手术联合治疗的复发率相当。然而，本次系统评价和荟萃分析中的研究主要是容易出现治疗偏倚的单臂研究。未来的研究需要进一步调查对于特定患者的 cSDH，单独的 MMAE 是否可以作为 MMAE 和手术联合治疗的有效替代方案。