Outcomes after middle meningeal artery embolization using coils alone for chronic subdural hematoma: A systematic review and single-arm meta-analysis.

Matthan Tharakan, Steven G Stagg, Brandon De La Torre, Beste Gulsuna, Kishore Balasubramanian, Burak Özaydin, Uttam Verma, Shyian Jen, Hakeem J Shakir

Abstract readSystematic ReviewMeta-Analysis

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In one paragraph

Synthesis in Neurosurgical review, 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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5 · Who and what money

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9 authors.

Matthan TharakanDepartment of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73105, USA.

Steven G StaggDepartment of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73105, USA.

Brandon De La TorreDepartment of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73105, USA.

Beste GulsunaDepartment of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73105, USA.

Kishore BalasubramanianDepartment of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73105, USA.

Burak ÖzaydinDepartment of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73105, USA.

Uttam VermaDepartment of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73105, USA.

Shyian JenDepartment of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73105, USA.

Hakeem J ShakirDepartment of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73105, USA. hakeem-shakir@ou.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Coil-only middle meningeal artery embolization (MMAE) remains less well characterized in the literature compared to liquid or particulate embolization for chronic subdural hematoma (cSDH). This systematic review and single-arm meta-analysis summarized clinical, radiographic, procedural, and safety outcomes after coil-only MMAE for cSDH. This systematic review followed PRISMA guidelines. PubMed, Ovid MEDLINE, Web of Science Core Collection, and Scopus were searched for English-language studies evaluating coil-only MMAE for cSDH with ≥ 5 patients and ≥ 1 predefined endpoint. Risk of bias was assessed using ROBINS-I. Single-arm random-effects meta-analyses were performed for clinical and radiographic outcomes when sufficient data were available. Anesthetic approach was summarized descriptively. Ten studies comprising 397 patients and 502 embolizations were included. Recurrence was reported in 7 studies comprising 252 patients, with a pooled rate of 4.6% (95% CI, 1.7%-12.1%). Reintervention was reported in 9 studies comprising 345 patients, with a pooled rate of 7.5% (95% CI, 4.5%-12.3%). Procedure-related complications were reported in all 10 studies, with a pooled rate of 1.3% (95% CI, 0.5%-3.0%). Radiographic reduction > 50% was reported in 6 studies comprising 220 patients, with a pooled rate of 76.7% (95% CI, 55.0%-89.8%). Heterogeneity ranged from absent to substantial across outcomes, and 9 of 10 studies were judged to have serious risk of bias. In this meta-analysis based on studies with substantial risk of bias, coil-only MMAE for cSDH was associated with low pooled rates of recurrence, reintervention, and procedure-related complications; however, these estimates should be considered hypothesis-generating rather than definitive evidence. Most included studies were retrospective and nonrandomized, treatment contexts and outcome definitions were heterogeneous, and prediction intervals were wide for several endpoints. Coil-only MMAE may represent a potential anatomy-selective embolization strategy, but current evidence does not establish equivalence, noninferiority, or superiority relative to liquid or particulate embolic agents.

Indexed as

Embolization, TherapeuticHematoma, Subdural, ChronicMeningeal ArteriesHumansTreatment OutcomeChronic subdural hematomaCoil embolizationEmbolic agentMeta-analysisMiddle meningeal artery embolizationSystematic review

Identifiers

PMID42837031

DOI10.1007/s10143-026-04512-6

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