Gillespie Conor S, Veremu Munashe, Cook William H, Ashraf Mohammad, Lee Keng Siang, Chedid Youssef, Alam Ali M, Karepov Yevgeny, Davies Benjamin M, Edlmann Ellie, Papanagiotou Panagiotis, Korfias Stefanos, Santarius Thomas, Minett Thais, Hutchinson Peter J, Kolias Angelos
Department of Clinical Neurosciences, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK.
Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Acta Neurochir (Wien). 2025 Jun 10;167(1):166. doi: 10.1007/s00701-025-06587-4.
Middle Meningeal Artery Embolization (MMAE) has been proposed as adjunct and stand-alone treatment for Chronic Subdural Hematoma (CSDH). We aimed to meta-analyze three recently published randomized controlled trials, to reliably estimate the effect of MMAE. We also carried out a systematic review of ongoing trials and their key outcomes.
A PRISMA-compliant meta-analysis was conducted (PROSPERO ID CRD42024618816). Three published RCTs (MAGIC-MT, EMBOLISE, and STEM) assessing MMAE in CSDH were included. Trial primary outcomes were pooled for analysis using random effects models. Primary and secondary outcomes (recurrence/surgical rescue, functional outcome) were obtained, stratified by treatment group (undergoing surgery, and nonsurgical management). A descriptive review of trials in public registries was also conducted (search date 30th November 2024).
In total, 1432 patients were included from three trials in meta-analysis. Overall, MMAE reduced symptomatic progression or recurrence, but was not statistically significant (RR 0.50, 95% CI 0.23-1.06, P = 0.058). For the group undergoing surgery, MMAE was not associated with reduced recurrence (RR 0.60, 95% CI 0.19-1.88, P = 0.194). For nonsurgical management, MMAE reduced progression (RR 0.36, 95% CI 0.22-0.60, P < 0.001). MMAE did not influence functional outcome (RR 1.01, 95% CI 0.97-1.04, P = 0.790). From the literature search, there are twenty-one registered trials. Nineteen studies include arms assessing MMAE as an adjunct to surgery, eleven compare MMAE to observation, and four with surgery. The most common primary outcome is recurrence (47.8%, N = 11), either radiologically, or requiring a second surgery. Inclusion criteria, embolization agents, primary and secondary outcomes differed significantly between studies.
In this meta-analysis of three randomized controlled trials, the use of MMAE in patients undergoing surgery did not appear to significantly reduce recurrence or improve functional outcomes, but did reduce progression in nonsurgical cohorts. Further studies assessing these cohorts are ongoing.
脑膜中动脉栓塞术（MMAE）已被提议作为慢性硬膜下血肿（CSDH）的辅助治疗和独立治疗方法。我们旨在对最近发表的三项随机对照试验进行荟萃分析，以可靠地评估MMAE的效果。我们还对正在进行的试验及其关键结果进行了系统评价。
进行了一项符合PRISMA标准的荟萃分析（PROSPERO识别号CRD42024618816）。纳入了三项评估CSDH中MMAE的已发表随机对照试验（MAGIC-MT、EMBOLISE和STEM）。使用随机效应模型汇总试验主要结局进行分析。获得了主要和次要结局（复发/手术挽救、功能结局），并按治疗组（接受手术和非手术治疗）进行分层。还对公共注册库中的试验进行了描述性综述（检索日期为2024年11月30日）。
荟萃分析共纳入了三项试验中的1432例患者。总体而言，MMAE降低了症状性进展或复发，但差异无统计学意义（风险比[RR]0.50，95%置信区间[CI]0.23 - 1.06，P = 0.058）。对于接受手术的组，MMAE与降低复发率无关（RR 0.60，95% CI 0.19 - 1.88，P = 0.194）。对于非手术治疗，MMAE降低了进展率（RR 0.36，95% CI 0.22 - 0.60，P < 0.001）。MMAE不影响功能结局（RR 1.01，95% CI 0.97 - 1.04，P = 0.790）。从文献检索来看，有21项注册试验。19项研究包括评估MMAE作为手术辅助手段的组，11项将MMAE与观察进行比较，4项将其与手术进行比较。最常见的主要结局是复发（47.8%，N = 11），包括影像学复发或需要二次手术。研究之间的纳入标准、栓塞剂、主要和次要结局差异显著。
在这项对三项随机对照试验的荟萃分析中，MMAE在接受手术的患者中使用似乎并未显著降低复发率或改善功能结局，但确实降低了非手术队列中的进展率。评估这些队列的进一步研究正在进行中。
