Evidence map›Paper›PMID 40493076›Full record

SynthesisActa neurochirurgica2025

Middle meningeal artery embolization for chronic subdural hematoma: meta-analysis of three randomized controlled trials and review of ongoing trials.

Conor S Gillespie, Munashe Veremu, William H Cook, Mohammad Ashraf, Keng Siang Lee, Youssef Chedid, Ali M Alam, Yevgeny Karepov, Benjamin M Davies, Ellie Edlmann and 6 more

Registry-linked trialAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Acta neurochirurgica, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07626671 (Prospective Outcomes of MMA Embolization), which is not on this map. Cited by 16 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 3 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.

NCT07626671 not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Prospective Outcomes of MMA Embolization: A Prospective Single-center Registry Investigating Endovascular Therapy for Chronic Subdural Hematomas

TypeobservationalSponsorCharite University, Berlin, GermanyRan2026 to 2028Enrolled100ConditionsChronic Subdural HematomasArmsMiddle Meningeal Artery Embolization
3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
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  4. Review
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  6. Clinical outcomes of middle meningeal artery embolization in trauma-related chronic subdural hematoma.Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES · 2026
    Article
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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

16 authors.

Conor S GillespieDepartment of Clinical Neurosciences, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK. cg823@cam.ac.uk.
Munashe VeremuDepartment of Clinical Neurosciences, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK.
William H CookDepartment of Clinical Neurosciences, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK.
Mohammad AshrafWolfson School of Medicine, University of Glasgow, Glasgow, Scotland, UK.
Keng Siang LeeDepartment of Basic and Clinical Neurosciences, Maurice, Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience , King's College London, London, UK.
Youssef ChedidDepartment of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Ali M AlamInstitute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
Yevgeny KarepovDepartment of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Benjamin M DaviesDepartment of Clinical Neurosciences, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK.
Ellie EdlmannPenninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK.
Panagiotis PapanagiotouDepartment of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany.
Stefanos KorfiasDepartment of Neurosurgery, National & Kapodistrian University of Athens, Athens, Greece.
Thomas SantariusDepartment of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Thais MinettDepartment of Radiology, Cambridge University Hospitals NHS Trust, Cambridge, UK.
Peter J HutchinsonDepartment of Clinical Neurosciences, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK.
Angelos KoliasDepartment of Clinical Neurosciences, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMiddle 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.

methodsA 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).

resultsIn 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.

conclusionsIn 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.

Indexed as

Embolization, TherapeuticHematoma, Subdural, ChronicMeningeal ArteriesHumansRandomized Controlled Trials as TopicRecurrenceTreatment OutcomeChronic subdural hematomaMiddle meningeal artery embolizationMMAE

Identifiers

PMID40493076
PMCPMC12152056

What OpenQuestion holds

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Registered trials

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.