Evidence map›Paper›PMID 40392287›Full record

SynthesisNeuroradiology2025

Comparative analysis of Onyx, squid, and n-BCA in middle meningeal artery embolization for chronic subdural hematoma: a meta-analysis of randomized controlled trials.

Ali Mortezaei, Nadir Al-Saidi, Leila Ghorbi, Khaled M Taghlabi, Bardia Hajikarimloo, Mohammad Amin Habibi, Ibrahim Mohammadzadeh, Redi Rahmani, Visish M Srinivasan, Jan-Karl Burkhardt and 1 more

Abstract readMeta-AnalysisSystematic ReviewComparative Study
PubMed Publisher
In one paragraph

Synthesis in Neuroradiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Ali MortezaeiGonabad University of Medical Sciences, Gonābād, Islamic Republic of Iran. alimortezaei97@yahoo.com.
Nadir Al-SaidiCentral Michigan University, Mount Pleasant, USA.
Leila GhorbiGonabad University of Medical Sciences, Gonābād, Islamic Republic of Iran.
Khaled M TaghlabiHouston Methodist, Houston, USA.
Bardia HajikarimlooUniversity of Virginia, Charlottesville, USA.
Mohammad Amin HabibiTehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
Ibrahim MohammadzadehShahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran.
Redi RahmaniUniversity of Pennsylvania, Philadelphia, USA.
Visish M SrinivasanUniversity of Pennsylvania, Philadelphia, USA.
Jan-Karl BurkhardtUniversity of Pennsylvania, Philadelphia, USA. jan.burkhardt@pennmedicine.upenn.edu.
Amir H FarajiHouston Methodist, Houston, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSelection of an embolic agent for middle meningeal artery embolization (MMAE) in a chronic subdural hematoma (cSDH) is a subject of debate and is limited to observational data. We report the first meta-analysis that exclusively assessed randomized controlled trials (RCTs) to address this gap.

methodsA systematic review and meta-analysis was conducted, incorporating all available RCTs that compared MMAE plus standard of care (SOC) versus SOC alone for cSDH usingeither Onyx, n-BCA, and Squid as embolic agent for embolization. Primary outcomes were the rate of hematoma recurrence/progression and the need for reoperation. Secondary outcomes included serious adverse events (SAE), all-cause mortality, functional independence (defined as a Modified Rankin Scale (mRS) score of 0-2), and the rate of successful embolization. To assess heterogeneity, a fixed-effect or random-effects model was applied, depending on statistical significance (I²>50%, P < 0.1).

resultsFour RCTs, with 894 patients in the MMAE plus SOC group and 914 patients in the SOC alone group, were identified and met our standard for analysis. Results revealed significant superiority of n-BCA compared to Onyx and Squid in lower all-cause mortality at last follow-up. There was no significant difference in using Onyx, Squid, and n-BCA in recurrence at the last follow-up (P = 0.36), reoperation at the last follow-up (P = 0.55), and successful embolization (P = 0.52), and 90-day functional independence (P = 0.076) between trials. Additionally, further analysis on safety outcomes showed no significant difference between embolic agents in SAE at last follow-up (P = 0.78), embolization-related complications (P = 0.087), new onset ischemic stroke (P = 0.98), and deep venous thrombosis (P = 0.94).

conclusionThis meta-analysis of RCTs suggests that while n-BCA is associated with lower all-cause mortality compared to Onyx and Squid in MMAE for cSDH, all three embolic agents demonstrate comparable efficacy and safety.

Indexed as

Dimethyl SulfoxideEmbolization, TherapeuticHematoma, Subdural, ChronicMeningeal ArteriesPolyvinylsTantalumHumansRandomized Controlled Trials as TopicTreatment OutcomeDimethyl Sulfoxideethylene-vinyl alcohol copolymerOnyx copolymerPolyvinylsTantalumChronic subdural hematomaEmbolic agentsMiddle meningeal artery embolizationn-BCAOnyxSquid

Identifiers

PMID40392287

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.