Title: MMA embolization in treatment for adult CSDH: A systematic review and meta analysis
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.
This systematic review in line with the PRISMA statement to perform a literature search.
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%).
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.