INTRODUCTION Refractory or chronic subdural hematomas (cSDH) constitute a challenging entity that neurosurgeons face frequently nowadays. Middle meningeal artery embolization (MMAE) has emerged in the recent years as a promising treatment option. However, solid evidence that can dictate management guidelines is still lacking. METHODS We conducted a systematic review and meta-analysis (MA) in compliance with the PRISMA guidelines to evaluate the efficacy and safety of MMAE compared with conventional treatments for refractory or cSDH. Databases were searched up to March 2019. Using a random-effects model, meta-analyses of proportions and risk difference were conducted recurrence, need for surgical rescue, and complications. RESULTS Eleven studies (177 patients) were included. Majority (116, 69%) were males with a weighted mean age of 71 + -19.5 years. Meta-analysis of proportions showed treatment failure to be 2.8%, need for surgical rescue 2.7%, and embolization-related complications 1.2%. Meta-analysis of risk-difference between embolized and non-embolized patients showed a 26% (p < 0.001, 95% CI 21%-31%, I2 = 0) lower risk of hematoma recurrence in MMAE. Similarly, in the embolized group, the need for surgical rescue was 20% less (p < 0.001, 95% CI = 12%-27%, I2 = 12.4), and complications were 3.6% less (p = 0.008, 95% CI 1%-6%, I2 = 0) compared to conventional groups. CONCLUSIONS Although MMAE appears to be a promising treatment for refractory or cSDH, drawing definitive conclusions remains limited by paucity of data and small sample sizes. Multicenter, randomized, prospective trials are needed to compare embolization to conventional treatments like watchful waiting, medical management, or surgical evacuation. More extensive research on MMAE could begin a new era in the minimally invasive management of cSDH.

中文翻译：

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脑膜中动脉栓塞治疗难治性或慢性硬膜下血肿的疗效和安全性：系统评价和荟萃分析。

引言难治性或慢性硬膜下血肿（cSDH）构成当今神经外科医生经常面临的挑战性实体。近年来，脑膜中动脉栓塞术（MMAE）已成为一种有前途的治疗选择。但是，仍然缺乏能够决定管理准则的可靠证据。方法我们按照PRISMA指南进行了系统评价和荟萃分析（MA），以评估MMAE与常规治疗难治性或cSDH的疗效和安全性。检索到2019年3月的数据库。使用随机效应模型，对比例，风险差异进行荟萃分析，以进行复发，手术救护和并发症的分析。结果纳入11项研究（177例患者）。多数（116，69％）是男性，加权平均年龄为71 + -19。5年。荟萃分析显示，治疗失败率为2.8％，需要手术救助的为2.7％，与栓塞相关的并发症为1.2％。栓塞和非栓塞患者之间风险差异的荟萃分析显示，MMAE中血肿复发的风险降低了26％（p <0.001，95％CI 21％-31％，I2 = 0）。同样，在栓塞治疗组中，手术抢救的需求减少了20％（p <0.001，95％CI = 12％-27％，I2 = 12.4），并发症减少了3.6％（p = 0.008，95％CI与常规组相比，为1％-6％，I2 = 0）。结论尽管MMAE似乎是治疗难治性或cSDH的有前途的方法，但由于缺乏数据和小样本量，得出明确的结论仍然受到限制。需要进行多中心，随机，前瞻性试验，以比较栓塞与常规治疗（如观察等待，医疗管理或外科疏散。对MMAE的更广泛研究可能会在cSDH的微创管理方面开始一个新时代。