The Journal of Cerebrovascular and Endovascular Neurosurgery

Abstract - Clinical Article

J Cerebrovasc Endovasc Neurosurg. 2024 26(1): 11-22

Safety and efficacy comparison of embolic agents for middle meningeal artery embolization for chronic subdural hematoma

Nathaniel R. Ellens1, Derrek Schartz2, Gurkirat Kohli1, Redi Rahmani1, Sajal Medha K. Akkipeddi1, Thomas K. Mattingly1, Tarun Bhalla1, Matthew T. Bender1

1Department of Neurosurgery, University of Rochester Medical Center, New York, USA 2Department of Imaging Sciences, University of Rochester Medical Center, New York, USA

Objective: To perform a systematic review and meta-analysis evaluating the efficacy of middle meningeal artery embolization in terms of both clinical and radiographic outcomes, when performed with different embolic agents. Methods: A systematic literature review and meta-analysis was performed to evaluate the impact of embolic agents on outcomes for middle meningeal artery (MMA) embolization. The use of polyvinyl alcohol (PVA) with or without (±) coils, N-butyl cyanoacrylate (n-BCA) ± coils, and Onyx alone were separately evaluated. Primary outcome measures were recurrence, the need for surgical rescue and in-hospital periprocedural complications. Results: Thirty-one studies were identified with a total of 1,134 patients, with 786 receiving PVA, 167 receiving n-BCA, and 181 patients receiving Onyx. There was no difference in the recurrence rate (5.5% for PVA, 4.5% for n-BCA, and 6.5% for Onyx, with P=0.71) or need for surgical rescue (5.0% for PVA, 4.0% for n-BCA, and 6.9% for Onyx, with P=0.89) based on the embolic agent. Procedural complications also did not differ between embolic agents (1.8% for PVA, 3.6% for n-BCA, and 1.6% for Onyx, with P=0.48). Conclusions: Rates of recurrence, need for surgical rescue, and periprocedural complication following MMA embolization are not impacted by the type of embolic agent utilized. Ongoing clinical trials may be used to further investigate these findings.

Key words : Chronic subdural hematoma, Embolization, Embolic agent, Endovascular procedures, Middle meningeal artery