Evidence map›Paper›PMID 41099761›Full record

SynthesisNeuroradiology2025

Efficacy of middle meningeal artery embolization combined with surgery versus standalone surgery for chronic subdural hematoma: a comprehensive systematic review and Meta-Analysis with separate analysis of randomized controlled trials.

Ibrahim Mohammadzadeh, Bardia Hajikarimloo, Amirhossein Zare, Shahin Mohammadzadeh, Pooya Eini, Saba Aghajani, Ali Mortezaei, Mohammad Amin Habibi, Kivanc Yangi, Ahmet Günkan and 1 more

Abstract readComparative StudyMeta-AnalysisSystematic Review
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 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–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

4 citing papers in PubMed.

  1. Temporal Pattern of Radiological Resolution in Chronic Subdural Hematoma After Middle Meningeal Artery Embolization: A Prospective 2-Center Study.Medical science monitor : international medical journal of experimental and clinical research · 2026
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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

11 authors.

Ibrahim MohammadzadehSkull Base Research Center, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Tehran, Iran, Islamic Republic of. Ibrahim.mdz7777@gmail.com.
Bardia HajikarimlooDepartment of Neurological Surgery, University of Virginia, Charlottesville, VA, USA, Virginia, United States.
Amirhossein ZareNeurology Department, Tehran university of medical sciences, Tehran, Iran, Tehran, Iran, Islamic Republic of.
Shahin MohammadzadehSkull Base Research Center, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Tehran, Iran, Islamic Republic of.
Pooya EiniCardiovascular Research Center, Rajaie Cardiovascular Institute, Tehran, Iran, Tehran, Iran, Islamic Republic of.
Saba AghajaniDepartment of Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Tehran, Iran, Islamic Republic of.
Ali MortezaeiStudent Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran, Gonabad, Iran, Islamic Republic of.
Mohammad Amin HabibiDepartment of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran, Tehran, Iran, Islamic Republic of.
Kivanc YangiThe Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States, Arizona, United States.
Ahmet GünkanDepartment of Radiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey, Istanbul, Turkey.
Pascal JabbourThomas Jefferson University, Neurological Surgery, Philadelphia, PA, US, Philadelphia, United States. Pascal.Jabbour@jefferson.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundChronic subdural hematoma (CSDH) is a prevalent neurosurgical condition with high recurrence rates after standard surgical evacuation. Middle meningeal artery embolization (MMAE) has emerged as a potential adjunct to reduce recurrence by targeting the vascular supply of neomembranes.

objectiveTo evaluate the efficacy and safety of MMAE combined with surgery versus standalone surgical evacuation in patients with CSDH, through a comprehensive systematic review and meta-analysis, including separate analysis of randomized controlled trials (RCTs).

methodsA systematic search of PubMed, Scopus, Web of Science, Embase, and Google Scholar was performed through March 2025. Dual-arm studies comparing MMAE plus surgery with surgery alone were included. Outcomes of interest were recurrence, complications, all-cause mortality, and functional outcome (modified Rankin Scale ≤ 2; mRS ≤ 2). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects model. Bias and evidence certainty were assessed via RoB tools and GRADE.

resultsTwenty-five studies (6 RCTs, 19 observational) comprising 119,812 patients were included. MMAE plus surgery significantly reduced recurrence (RR = 0.47, 95% CI: 0.36-0.62, p < 0.001; I² = 3.0%), without increasing complications (RR = 1.02, 95% CI: 0.8-1.3) or mortality (RR = 0.98, 95% CI: 0.72-1.33) compared with surgery alone. Functional outcomes were similar between both approaches (RR = 1.07, 95% CI: 0.93-1.23). Subanalysis of RCTs, was consistent with overall analysis showing a significant reduction in recurrence (RR = 0.44, 95% CI: 0.25-0.78) with MMAE plus surgery, without an increase in complications or mortality compared to surgery alone.

conclusionMMAE as an adjunct to surgery significantly lowers recurrence in CSDH. No significant differences in complications, mortality, or functional outcomes were detected compared with surgery alone; however, these outcomes are less common, and available studies may not have been adequately powered to exclude small but clinically meaningful effects.

Indexed as

Embolization, TherapeuticHematoma, Subdural, ChronicMeningeal ArteriesNeurosurgical ProceduresCombined Modality TherapyHumansRandomized Controlled Trials as TopicRecurrenceTreatment OutcomeBurr-hole drainageChronic subdural hematomaCraniotomyEndovascular neurosurgeryMeta-analysisMiddle meningeal artery embolization

Identifiers

PMID41099761

What OpenQuestion holds

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Registered trials

None linked

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.