{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:43:18Z","timestamp":1793144598825,"version":"4.5.0"},"reference-count":20,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Neuroradiol J"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The safety and efficacy of the middle meningeal artery embolization (MMAE) in patients with non-acute or chronic subdural hematoma (cSDH) has significant reporting within recent literature, however, mainly in the form of observational data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a systematic review and meta-analysis including all available randomized clinical trials (RCTs) that compared MMAE in addition to standard of care (SOC) versus SOC alone for cSDH. The primary outcome was the rate of recurrence and reoperation. Secondary outcomes included serious adverse events (SAEs), mortality rate, independent ambulation (modified Rankin Scale (mRS) score 0\n                      <jats:bold>\u2013<\/jats:bold>\n                      3), and changes in hematoma characteristics at 90\u00a0days. The fixed-effect or random-effects model was used based on the significancy of the heterogenicity (I\n                      <jats:sup>2<\/jats:sup>\n                      &gt; 50%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .1).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Findings showed significant superiority of MMAE over SOC in 90-day recurrence (RR = 0.55, 95% CI = 0.36\n                      <jats:bold>\u2013<\/jats:bold>\n                      0.83,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .0047, I\n                      <jats:sup>2<\/jats:sup>\n                      = 43.3%), reoperation within 180\u00a0days (RR = 0.38, 95% CI = 0.26\u20130.56,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001, I\n                      <jats:sup>2<\/jats:sup>\n                      = 0.0%), ambulatory functional outcome (RR = 1.034, 95% CI = 1.0\u20131.07,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .0296, I\n                      <jats:sup>2<\/jats:sup>\n                      = 53.9%), SAE at any time (RR = 0.59, 95% CI = 0.38\u20130.94,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .025, , I\n                      <jats:sup>2<\/jats:sup>\n                      = 0.0%), and 90-day any-cause mortality (RR = 0.29, 95% CI = 0.14\u20130.6,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .0008, I\n                      <jats:sup>2<\/jats:sup>\n                      = 0.0%). Successful embolization and 30-day embolization-related complications occurred in 99.2% (95% CI = 94.54%\n                      <jats:bold>\u2013<\/jats:bold>\n                      100%) and 1.18% (95% CI = 0.39%\n                      <jats:bold>\u2013<\/jats:bold>\n                      2.31%) of patients, respectively. Additionally, subgroup analyses on major and pilot RCTs, comparison of embolic agents, and MMAE adjuvant to surgery versus surgery alone confirmed these findings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MMAE appears to be safe and effective in the management of cSDH with low recurrence and SAE rate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19714009251389579","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T21:22:06Z","timestamp":1761081726000},"page":"290-298","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Middle meningeal artery embolization versus standard of care for chronic subdural hematoma: Meta-analysis of randomized controlled trials"],"prefix":"10.1177","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7217-3264","authenticated-orcid":false,"given":"Ali","family":"Mortezaei","sequence":"first","affiliation":[{"name":"Gonabad University of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadir","family":"Al-Saidi","sequence":"additional","affiliation":[{"name":"Central Michigan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiana","family":"Yahyaei","sequence":"additional","affiliation":[{"name":"Gonabad University of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Abdelsalam","sequence":"additional","affiliation":[{"name":"University of Miami"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Guada Delgado","sequence":"additional","affiliation":[{"name":"University of Miami"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Hanna","sequence":"additional","affiliation":[{"name":"University of Miami"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0131-5699","authenticated-orcid":false,"given":"Adam A","family":"Dmytriw","sequence":"additional","affiliation":[{"name":"Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women\u2019s Hospital"},{"name":"RADIS Lab and Neurointerventional &amp; Neuroanalytics Collaboration (NAN-C), St. Michael's Hospital, University of Toronto and Toronto Metropolitan University, Toronto, ON"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Redi","family":"Rahmani","sequence":"additional","affiliation":[{"name":"University of Louisville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adib A","family":"Abla","sequence":"additional","affiliation":[{"name":"University of Miami"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M","family":"Starke","sequence":"additional","affiliation":[{"name":"University of Miami"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,10,21]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.3171\/2014.9.JNS141550"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMe2410915"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.3340\/jkns.2010.48.6.518"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000298908.94129.67"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.3340\/jkns.2008.43.1.11"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.00923"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2401201"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2409845"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2313472"},{"issue":"1","key":"e_1_3_4_11_2","first-page":"A104.2","article-title":"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","volume":"13","author":"Kellner C","year":"2021","unstructured":"Kellner C, Al-Mufti F, Gupta R, et al. 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. 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