Evidence map›Paper›PMID 40804509›Full record

SynthesisNeurosurgical review2025

Middle meningeal artery embolization for chronic subdural hematoma in octogenarians and nonagenarians: an individual patient pooled meta-analysis.

Rahim Abo Kasem, Zachary Hubbard, Julio Isidor, Joshua Venegas, Omar Alwakaa, Felipe Ramirez-Velandia, Muhammed Amir Essibayi, Adnan Rehawi, Christopher S Ogilvy, Justin H Granstein and 1 more

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PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Neurosurgical review, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing 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

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

  1. Pooled it
  2. Article
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.

Rahim Abo KasemDepartment of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA.
Zachary HubbardDepartment of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA.
Julio IsidorDepartment of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA.
Joshua VenegasDepartment of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA.
Omar AlwakaaDivision of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Felipe Ramirez-VelandiaDivision of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Muhammed Amir EssibayiDepartment of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Adnan RehawiFaculty of Medicine, Damascus University, Damascus, Syria.
Christopher S OgilvyDivision of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Justin H GransteinDivision of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Alejandro M SpiottaDivision of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. spiotta@musc.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Chronic subdural hematoma (cSDH) is a highly common neurosurgical condition with significant burden in the elderly, and patients aged ≥ 80 represent nearly one-third of cases. Middle meningeal artery embolization (MMAE) has emerged as a promising treatment method to reduce hematoma growth and recurrence; however, octogenarians and nonagenarians remain underrepresented in clinical trials. We conducted a systematic review and meta-analysis of individual patient data to evaluate outcomes of MMAE in this high-risk group. We systematically searched PubMed, Scopus, and Web of Science through March 2025 for studies reporting patients aged ≥ 80 years treated with MMAE for cSDH. Individual-level data were extracted and pooled. Clinical, procedural, and radiographic outcomes were summarized. Multivariable mixed-effects logistic regression identified predictors of hematoma resolution and extended hospital stay (LOS ≥ 75th percentile). Twenty-six studies including 86 patients (mean age 83 years; 36% ≥90 years) met inclusion. Most were male (70%) and had comorbidities such as hypertension (57%) and diabetes (21%). MMAE was performed alone in 64% of cases and with surgery in 36%. Transfemoral access was used in 74%, while transradial access (associated with shorter LOS) was underutilized, especially in patients ≥ 90 (3%). Complication and in-hospital mortality rates were low (5.8% and 1.2%, respectively). At discharge, 81% returned home. Complete hematoma resolution occurred in 56%, more likely with adjunctive coiling (aOR 4.01) and less likely with antithrombotic use (aOR 0.12). Extended LOS was associated with age ≥ 90 (aOR 2.1) and general anesthesia (aOR 1.7). MMAE is safe and effective in patients aged ≥ 80. While outcomes are favorable across age groups, transradial access and conscious sedation may reduce hospital stay and anesthesia-related risks in this population. Future trials should prioritize inclusion of this high-risk group to guide age-appropriate, evidence-based care.

Indexed as

Embolization, TherapeuticHematoma, Subdural, ChronicMeningeal ArteriesAged, 80 and overFemaleHumansLength of StayMaleTreatment OutcomeChronic subdural hematoma.Middle meningeal artery embolizationNonagenariansOctogenarians

Identifiers

PMID40804509
PMCPMC12350427

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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.