{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T08:31:44Z","timestamp":1794040304246,"version":"4.8.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100006942","name":"Medical University of South Carolina","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100006942","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurosurg Rev"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Chronic subdural hematoma (cSDH) is a highly common neurosurgical condition with significant burden in the elderly, and patients aged\u2009\u2265\u200980 represent nearly one-third of cases. Middle meningeal artery embolization (MMAE) has emerged as a promising treatment method to reduce hematoma growth and recurrence; however, octogenarians and nonagenarians remain underrepresented in clinical trials. We conducted a systematic review and meta-analysis of individual patient data to evaluate outcomes of MMAE in this high-risk group.\u00a0We systematically searched PubMed, Scopus, and Web of Science through March 2025 for studies reporting patients aged\u2009\u2265\u200980 years treated with MMAE for cSDH. Individual-level data were extracted and pooled. Clinical, procedural, and radiographic outcomes were summarized. Multivariable mixed-effects logistic regression identified predictors of hematoma resolution and extended hospital stay (LOS\u2009\u2265\u200975th percentile).\u00a0Twenty-six studies including 86 patients (mean age 83 years; 36% \u226590 years) met inclusion. Most were male (70%) and had comorbidities such as hypertension (57%) and diabetes (21%). MMAE was performed alone in 64% of cases and with surgery in 36%. Transfemoral access was used in 74%, while transradial access (associated with shorter LOS) was underutilized, especially in patients\u2009\u2265\u200990 (3%). Complication and in-hospital mortality rates were low (5.8% and 1.2%, respectively). At discharge, 81% returned home. Complete hematoma resolution occurred in 56%, more likely with adjunctive coiling (aOR 4.01) and less likely with antithrombotic use (aOR 0.12). Extended LOS was associated with age\u2009\u2265\u200990 (aOR 2.1) and general anesthesia (aOR 1.7).\u00a0MMAE is safe and effective in patients aged\u2009\u2265\u200980. While outcomes are favorable across age groups, transradial access and conscious sedation may reduce hospital stay and anesthesia-related risks in this population. Future trials should prioritize inclusion of this high-risk group to guide age-appropriate, evidence-based care.<\/jats:p>","DOI":"10.1007\/s10143-025-03743-3","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T02:34:24Z","timestamp":1755138864000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Middle meningeal artery embolization for chronic subdural hematoma in octogenarians and nonagenarians: an individual patient pooled meta-analysis"],"prefix":"10.1007","volume":"48","author":[{"given":"Rahim Abo","family":"Kasem","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Hubbard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio","family":"Isidor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Venegas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Alwakaa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe","family":"Ramirez-Velandia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammed Amir","family":"Essibayi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Rehawi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher S.","family":"Ogilvy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin H.","family":"Granstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro M.","family":"Spiotta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"key":"3743_CR1","doi-asserted-by":"publisher","unstructured":"Balser D, Farooq S, Mehmood T, Reyes M, Samadani U (2015) Actual and projected incidence rates for chronic subdural hematomas in united States veterans administration and civilian populations. Published Online November 1. https:\/\/doi.org\/10.3171\/2014.9.JNS141550","DOI":"10.3171\/2014.9.JNS141550"},{"issue":"5","key":"3743_CR2","doi-asserted-by":"publisher","first-page":"1438","DOI":"10.1161\/STROKEAHA.123.044129","volume":"55","author":"P Kan","year":"2024","unstructured":"Kan P, Fiorella D, Dabus G et al (2024) ARISE I consensus statement on the management of chronic subdural hematoma. Stroke 55(5):1438\u20131448. https:\/\/doi.org\/10.1161\/STROKEAHA.123.044129","journal-title":"Stroke"},{"key":"3743_CR3","doi-asserted-by":"publisher","unstructured":"Chen H, Colasurdo M, Malhotra A, Gandhi D, Bodanapally UK (2024) Advances in chronic subdural hematoma and membrane imaging. Front Neurol 15. https:\/\/doi.org\/10.3389\/fneur.2024.1366238","DOI":"10.3389\/fneur.2024.1366238"},{"key":"3743_CR4","doi-asserted-by":"publisher","first-page":"e166","DOI":"10.1016\/j.wneu.2020.05.060","volume":"141","author":"SN Neifert","year":"2020","unstructured":"Neifert SN, Chaman EK, Hardigan T et al (2020) Increases in subdural hematoma with an aging Population\u2014the future of American cerebrovascular disease. World Neurosurg 141:e166\u2013e174. https:\/\/doi.org\/10.1016\/j.wneu.2020.05.060","journal-title":"World Neurosurg"},{"issue":"8","key":"3743_CR5","doi-asserted-by":"publisher","first-page":"1454","DOI":"10.1093\/gerona\/glaa293","volume":"76","author":"NA Shlobin","year":"2021","unstructured":"Shlobin NA, Kedda J, Wishart D, Garcia RM, Rosseau G (2021) Surgical management of chronic subdural hematoma in older adults: A systematic review. J Gerontol Ser A 76(8):1454\u20131462. https:\/\/doi.org\/10.1093\/gerona\/glaa293","journal-title":"J Gerontol Ser A"},{"issue":"1","key":"3743_CR6","doi-asserted-by":"publisher","first-page":"e000906","DOI":"10.1161\/SVIN.123.000906","volume":"4","author":"T Tudor","year":"2024","unstructured":"Tudor T, Capone S, Vivanco-Suarez J et al (2024) Middle meningeal artery embolization for chronic subdural hematoma: A review of established and emerging embolic agents. Stroke Vasc Interv Neurol 4(1):e000906. https:\/\/doi.org\/10.1161\/SVIN.123.000906","journal-title":"Stroke Vasc Interv Neurol"},{"key":"3743_CR7","doi-asserted-by":"publisher","unstructured":"Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Published Online March 29. https:\/\/doi.org\/10.1136\/bmj.n71","DOI":"10.1136\/bmj.n71"},{"issue":"11","key":"3743_CR8","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1002\/sim.1186","volume":"21","author":"JPT Higgins","year":"2002","unstructured":"Higgins JPT, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539\u20131558. https:\/\/doi.org\/10.1002\/sim.1186","journal-title":"Stat Med"},{"key":"3743_CR9","unstructured":"R: The R Project for Statistical Computing. Accessed April 12, (2025) https:\/\/www.r-project.org\/"},{"issue":"1","key":"3743_CR10","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1186\/s12974-017-0881-y","volume":"14","author":"E Edlmann","year":"2017","unstructured":"Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KLH, Hutchinson PJ (2017) Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation 14(1):108. https:\/\/doi.org\/10.1186\/s12974-017-0881-y","journal-title":"J Neuroinflammation"},{"key":"3743_CR11","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1016\/j.wneu.2018.05.037","volume":"116","author":"DC Holl","year":"2018","unstructured":"Holl DC, Volovici V, Dirven CMF et al (2018) Pathophysiology and nonsurgical treatment of chronic subdural hematoma: from past to present to future. World Neurosurg 116:402\u2013411e2. https:\/\/doi.org\/10.1016\/j.wneu.2018.05.037","journal-title":"World Neurosurg"},{"issue":"2","key":"3743_CR12","doi-asserted-by":"publisher","first-page":"87","DOI":"10.13004\/kjnt.2015.11.2.87","volume":"11","author":"MW Ju","year":"2015","unstructured":"Ju MW, Kim SH, Kwon HJ et al (2015) Comparision between brain atrophy and subdural volume to predict chronic subdural hematoma: volumetric CT imaging analysis. Korean J Neurotrauma 11(2):87\u201392. https:\/\/doi.org\/10.13004\/kjnt.2015.11.2.87","journal-title":"Korean J Neurotrauma"},{"issue":"20","key":"3743_CR13","doi-asserted-by":"publisher","first-page":"1890","DOI":"10.1056\/NEJMoa2313472","volume":"391","author":"JM Davies","year":"2024","unstructured":"Davies JM, Knopman J, Mokin M et al (2024) Adjunctive middle meningeal artery embolization for subdural hematoma. N Engl J Med 391(20):1890\u20131900. https:\/\/doi.org\/10.1056\/NEJMoa2313472","journal-title":"N Engl J Med"},{"issue":"9","key":"3743_CR14","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1056\/NEJMoa2409845","volume":"392","author":"D Fiorella","year":"2025","unstructured":"Fiorella D, Monteith SJ, Hanel R et al (2025) Embolization of the middle meningeal artery for chronic subdural hematoma. N Engl J Med 392(9):855\u2013864. https:\/\/doi.org\/10.1056\/NEJMoa2409845","journal-title":"N Engl J Med"},{"key":"3743_CR15","doi-asserted-by":"publisher","unstructured":"Kellner C, Al-Mufti F, Gupta R, Jankowitz B, Starke R, Rai A (2021) 75 A prospective, multi-center, randomized controlled pivotal study to evaluate the safety and effectiveness of trufill\u00ae NBCA embolization of the middle meningeal artery for the treatment of subdural hematoma \u2013 The membrane study. J NeuroInterventional Surg 13(Suppl 1):A104\u2013A105. https:\/\/doi.org\/10.1136\/neurintsurg-2021-SNIS.170","DOI":"10.1136\/neurintsurg-2021-SNIS.170"},{"issue":"20","key":"3743_CR16","doi-asserted-by":"publisher","first-page":"1901","DOI":"10.1056\/NEJMoa2401201","volume":"391","author":"J Liu","year":"2024","unstructured":"Liu J, Ni W, Zuo Q et al (2024) Middle meningeal artery embolization for nonacute subdural hematoma. N Engl J Med 391(20):1901\u20131912. https:\/\/doi.org\/10.1056\/NEJMoa2401201","journal-title":"N Engl J Med"},{"key":"3743_CR17","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1016\/j.wneu.2017.07.044","volume":"106","author":"J Bartek","year":"2017","unstructured":"Bartek J, Sj\u00e5vik K, Kristiansson H et al (2017) Predictors of recurrence and complications after chronic subdural hematoma surgery: A Population-Based study. World Neurosurg 106:609\u2013614. https:\/\/doi.org\/10.1016\/j.wneu.2017.07.044","journal-title":"World Neurosurg"},{"issue":"5","key":"3743_CR18","doi-asserted-by":"publisher","first-page":"379","DOI":"10.14740\/jocmr1907w","volume":"6","author":"S Tabuchi","year":"2014","unstructured":"Tabuchi S, Kadowaki M (2014) Chronic subdural hematoma in patients over 90 years old in a super-aged society. J Clin Med Res 6(5):379\u2013383. https:\/\/doi.org\/10.14740\/jocmr1907w","journal-title":"J Clin Med Res"},{"key":"3743_CR19","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1016\/j.wneu.2024.09.002","volume":"191","author":"I Khan","year":"2024","unstructured":"Khan I, Shakir M, Hika B et al (2024) Failure rates of Conservative management of minimally symptomatic chronic subdural hematoma: A systematic review and Meta-Analysis. World Neurosurg 191:291\u2013302e1. https:\/\/doi.org\/10.1016\/j.wneu.2024.09.002","journal-title":"World Neurosurg"},{"key":"3743_CR20","doi-asserted-by":"publisher","first-page":"e154","DOI":"10.1016\/j.wneu.2024.01.075","volume":"184","author":"E Liu","year":"2024","unstructured":"Liu E, Zhou A, Tilbury N, Persad A, Radic J (2024) Chronic subdural hematoma drainage under local versus general anesthesia: systematic review and Meta-Analysis. World Neurosurg 184:e154\u2013e165. https:\/\/doi.org\/10.1016\/j.wneu.2024.01.075","journal-title":"World Neurosurg"},{"issue":"1","key":"3743_CR21","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1227\/neu.0000000000002874","volume":"95","author":"MM Salem","year":"2024","unstructured":"Salem MM, Sioutas GS, Khalife J et al (2024) General versus nongeneral anesthesia for middle meningeal artery embolization for chronic subdural hematomas: multicenter propensity score matched study. Neurosurgery 95(1):76. https:\/\/doi.org\/10.1227\/neu.0000000000002874","journal-title":"Neurosurgery"},{"issue":"6","key":"3743_CR22","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1136\/neurintsurg-2019-015569","volume":"12","author":"JS Catapano","year":"2020","unstructured":"Catapano JS, Fredrickson VL, Fujii T et al (2020) Complications of femoral versus radial access in neuroendovascular procedures with propensity adjustment. J NeuroInterventional Surg 12(6):611\u2013615. https:\/\/doi.org\/10.1136\/neurintsurg-2019-015569","journal-title":"J NeuroInterventional Surg"},{"issue":"9","key":"3743_CR23","doi-asserted-by":"publisher","first-page":"2587","DOI":"10.1161\/STROKEAHA.119.025811","volume":"50","author":"O Khanna","year":"2019","unstructured":"Khanna O, Sweid A, Mouchtouris N et al (2019) Radial artery catheterization for neuroendovascular procedures. Stroke 50(9):2587\u20132590. https:\/\/doi.org\/10.1161\/STROKEAHA.119.025811","journal-title":"Stroke"},{"issue":"8","key":"3743_CR24","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1136\/neurintsurg-2018-014620","volume":"11","author":"SH Chen","year":"2019","unstructured":"Chen SH, Snelling BM, Shah SS et al (2019) Transradial approach for flow diversion treatment of cerebral aneurysms: a multicenter study. J Neurointerventional Surg 11(8):796\u2013800. https:\/\/doi.org\/10.1136\/neurintsurg-2018-014620","journal-title":"J Neurointerventional Surg"},{"issue":"4","key":"3743_CR25","doi-asserted-by":"publisher","first-page":"e222045","DOI":"10.1148\/radiol.222045","volume":"307","author":"MM Salem","year":"2023","unstructured":"Salem MM, Kuybu O, Nguyen Hoang A et al (2023) Middle meningeal artery embolization for chronic subdural hematoma: predictors of clinical and radiographic failure from 636 embolizations. Radiology 307(4):e222045. https:\/\/doi.org\/10.1148\/radiol.222045","journal-title":"Radiology"},{"key":"3743_CR26","doi-asserted-by":"publisher","first-page":"123541","DOI":"10.1016\/j.wneu.2024.11.124","volume":"194","author":"M Shafi","year":"2025","unstructured":"Shafi M, Badikol SR, Gerstl JVE et al (2025) Complications of middle meningeal artery embolization: A systematic review and Meta-Analysis. World Neurosurg 194:123541. https:\/\/doi.org\/10.1016\/j.wneu.2024.11.124","journal-title":"World Neurosurg"},{"issue":"5","key":"3743_CR27","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1227\/neu.0000000000003218","volume":"96","author":"MM Salem","year":"2025","unstructured":"Salem MM, Helal A, Gajjar AA et al (2025) Embolic materials\u2019 comparison in meningeal artery embolization for chronic subdural hematomas: multicenter propensity Score\u2013Matched analysis of 1070 cases. Neurosurgery 96(5):1067. https:\/\/doi.org\/10.1227\/neu.0000000000003218","journal-title":"Neurosurgery"},{"issue":"2","key":"3743_CR28","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1136\/bmjebm-2017-110853","volume":"23","author":"MH Murad","year":"2018","unstructured":"Murad MH, Sultan S, Haffar S, Bazerbachi F (2018) Methodological quality and synthesis of case series and case reports. BMJ Evid-Based Med 23(2):60\u201363. https:\/\/doi.org\/10.1136\/bmjebm-2017-110853","journal-title":"BMJ Evid-Based Med"}],"container-title":["Neurosurgical Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10143-025-03743-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10143-025-03743-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10143-025-03743-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T04:14:30Z","timestamp":1772079270000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10143-025-03743-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,14]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["3743"],"URL":"https:\/\/doi.org\/10.1007\/s10143-025-03743-3","relation":{},"ISSN":["1437-2320"],"issn-type":[{"value":"1437-2320","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,14]]},"assertion":[{"value":"25 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 July 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 July 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 August 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human ethics and consent to participate declarations"}},{"value":"The authors declare no competing interests.\u00a0","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This manuscript is a systematic review and individual patient pooled meta-analysis, not a clinical trial. Therefore, clinical trial registration is not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical trial registration"}}],"article-number":"600"}}