Risk of recurrence of subdural hematoma after EMMA vs surgical drainage - Systematic review and meta-analysis

Objective Chronic subdural hematoma (CSDH) is a common and debilitating neurological condition whose treatments, including burr hole drainage and craniotomy, suffer from high rates of recurrence and complication. Embolization of the middle meningeal artery (EMMA) is a promising minimally invasive approach to manage CSDH in a broad set of patients. Methods To evaluate the efficacy and safety of EMMA, a database search was conducted including the terms "subdural hematoma; embolization; embolized; middle meningeal" was performed and yielded a total of 260 results. Following exclusion based on predefined criteria, a total of four studies were identified and outcomes including recurrence rates and complication rates were extracted for analysis. Results Four studies including intervention and control groups were included with a total of n = 888 patients. The relative risk of CSDH recurrence in the EMMA (3.5%) compared to control group (23.5%) was significantly reduced when EMMA was performed (risk ratio = 0.17; 95% confidence interval (CI) 0.05-0.67). In addition, rates of complication were not significantly different between patients with conventional therapy and those who received EMMA (OR = 0.77; 95 confidence interval (CI) 0.3-1.99). Conclusion Based on limited data, EMMA reduces the risk of recurrence by 20% compared to surgical treatment for CSDH.