Consensus Statement on Middle Meningeal Artery Embolization in Chronic Subdural Hematoma Treatment: A Guideline from the Society of Vascular and Interventional Neurology Guidelines and Practice Standards Committee.

backgroundEmerging evidence from observational studies, meta-analyses, and clinical trials has reshaped the treatment landscape of chronic subdural hematoma (CSDH). This guideline provides updated recommendations on diagnosis, patient selection, and medical, surgical, and endovascular management.

methodsThe Society of Vascular and Interventional Neurology Guidelines and Practice Standards committee formed a writing group of interdisciplinary experts to review current literature. Recommendations were based on clinical trial data, observational studies, and expert consensus, following the Society of Vascular and Interventional Neurology Class of Recommendation and Level of Evidence framework.

resultsEMBOLISE (Embolization of the Middle Meningeal Artery With ONYX Liquid Embolic System for Subacute and Chronic Subdural Hematoma), STEM (SQUID Trial for the Embolization of the Middle Meningeal Artery for Treatment of Chronic Subdural Hematoma), MAGIC-MT (Managing Non-acute Subdural Hematoma Using Liquid Materials: A Chinese Randomized Trial of MMA Treatment), and MEMBRANE (Middle Meningeal Artery Embolization for the Treatment of Subdural Hematomas With TRUFILL n-butyl cyanoacrylate) trials highlight the efficacy and safety of middle meningeal artery embolization (MMAE) in CSDH. EMBOLISE (n = 400; MMAE with surgery, n = 197; surgery alone, n = 203) showed that MMAE plus surgery reduced 90-day hematoma recurrence to 4.1% versus 11.3% with surgery alone (relative risk = 0.36; 95% CI = 0.11-0.80;

conclusionsThese results suggest that MMAE plus standard treatment of CSDH shows promising results and may become a standard of care for managing CSDH in selected patients. These guidelines provide evidence-based recommendations for the diagnosis, patient selection, and treatment of CSDH.