SynthesisClinical neuroradiology2026
Embolic Agents for Middle Meningeal Artery Embolization in Chronic Subdural Hematoma: a Systematic Review and Comparative Pooled Analysis.
Synthesis in Clinical neuroradiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeMiddle meningeal artery (MMA) embolization has emerged as a promising alternative or supplement to surgery for chronic subdural hematoma (cSDH). However, the effectiveness of different embolic agents remains unclear.
methodsWe systematically reviewed 41 studies published up to September 2025, including 8 meta-analyses, 1 scoping review, and 32 clinical cohorts or series. Embolic agents evaluated included liquid agents (Onyx, Squid, n‑BCA), particulates (polyvinyl alcohol [PVA], microspheres), and coils. The primary endpoint was treatment failure, defined as symptomatic or radiological recurrence of cSDH requiring repeat intervention (repeat MMA embolization or surgical rescue); secondary outcomes included complications, mortality, and functional outcomes.
resultsNo embolic agent demonstrated consistent superiority in randomized trials, meta-analyses, or observational cohorts. Pooled recurrence rates were lowest with n‑BCA (0.8%), followed by Squid (3.6%), Onyx (4.4%), PVA particles (7.3%), and coils (9.0%). Although pooled recurrence appeared lowest with n‑BCA and highest with coils, most randomized and observational comparative studies did not detect statistically significant differences between embolic agents. Major complications were infrequent (≈1-3%) and similar across agents. Liquid embolics had significantly higher costs than PVA particles but did not lead to improved functional outcomes.
conclusionMMA embolization is a safe and effective treatment for cSDH. Outcomes are generally similar across different embolic agents, and selection should be based on anatomical factors, operator expertise, and resource availability rather than expectations of agent-specific effectiveness.
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