Title: MMA embolization in treatment for adult CSDH: A systematic review and meta analysis
Abstract:
Introduction:
Surgical intervention is a commonly used for CSDH. However, surgical evacuation of CSDH is not without a fair share of complications such as acute SDH formation or recurrence of CSDH. Endovascular embolization of the middle meningeal artery (MMA) has been emerged as a minimally invasive method in recent years for treatment of CSDH. Hence, this systematic review and meta-analysis aim to evaluate the effectiveness of MMAE in treating CSDH as adjective vs surgical treatment alone and MMAE as upfront vs surgical treatment.
Methods:
This systematic review in line with the PRISMA statement to perform a literature search.
Results:
There are 21 studies included in this review. There were eight studies included for Meta-Analysis with 321 patients in the MMAE group and 1193 patients in the ST group. This meta-analysis showed in less recurrence rate in MMAE group (P<0.00001, I2= 26%). We further divided the study population into different groups based on the indication of MMAE (Adjunctive or sole treatment). MMAE as adjective treatment is more favourable than the ST group (P=0.0002, I2=0%) in six studies. Two studies using MMAE as sole therapy also showed more favour to the MMAE group (P=0.02, I2= 0%). In the reoperation rate that the result is favored the experiment group with P<0.0001, I2=6%. In MMAE as adjunctive treatment is shown favour to ST group with P=0.004, I2= 0%. There is no significate difference in complication. The subgroup analysis did not show differences either. Similarly, there is no significant difference in mortality (P=0.53, I2= 0%) and mRS score (P=0.43, I2=73%).
Conclusion:
This study showed MMAE can be an adjunctive therapy together with surgical intervention without increase of complication and motility and mobility. High-quality randomise control trial is lacking; thus, further randomise control trial to confirm the findings and overall conclusion of this meta-analysis.
Audience Take Away:
- Identified the clinic problems from daily practices.
- Collaboration with surgeons working together to improve patients care and clinic outcome.
- Promote evidence base practice and to develop recommendation for further practices.
