Middle meningeal artery embolization: A scoping review of trends and outcomes by embolization material.

Background: Chronic subdural hematomas (cSDHs), blood collections under the dural layer of the brain, are common in the elderly and frequently linked to trauma and anticoagulation. As the global elderly population increases, the incidence of cSDH is expected to rise, straining healthcare systems. Middle meningeal artery embolization is a minimally invasive alternative to surgery, which could prove especially beneficial for elderly patients with multiple comorbidities or contraindications to surgery. However, the efficacy and patient-related outcomes associated with different embolization materials remain unknown. Methods: The authors conducted a scoping review of manuscripts published through August 2023 to assess outcomes associated with various embolization materials used in middle meningeal artery embolization for cSDH. Recurrence rates after embolization and complications were the primary outcomes. Results: The authors analyzed a total of 25 studies, reporting 1579 embolizations in 1362 patients. Embolic materials included particles (35.7%), liquid embolisates (31.5%), coils (3.2%), and combinations of the aforementioned materials (29.6%). Recurrence rates were low (5.1%), and the most common complications were seizures and strokes. The overall mortality was 1.4%, with three procedure-related deaths. Conclusion: With low recurrence and complication rates, middle meningeal artery embolization is a safe and effective treatment for cSDH. However, due to limitations in data availability, we were not able to link hematoma recurrence or complication rates with the type of embolization material used. To better understand the safety profiles of different materials, further large-scale studies are warranted.