{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T06:24:22Z","timestamp":1787293462550,"version":"build-2736575974"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Comparative studies on the middle meningeal artery (MMA) embolization versus conventional management (CM) to treat chronic subdural hematoma (CSDH) yield inconsistent findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This systematic review sought to meta-analyze studies comparing MMA embolization versus CM for treating CSDH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Terms including \u201chematoma\u201d, \u201csubdural\u201d, \u201cchronic\u201d, \u201cmeningeal arteries\u201d, \u201cembolization\u201d, and \u201ctherapeutic\u201d were applied to search PubMed, Embase, the Cochrane Library, and Web of Science databases from their inception to July 11, 2025. After independent reading, screening, and evaluation by two researchers, data were analyzed and processed using RevMan v5.4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Initially, 1,883 articles were retrieved. After eliminating 692 duplicates and excluding 1,087 articles that are conference abstracts, letters, or have ineligible research objectives, interventions, or outcomes, 104 articles were identified as potentially eligible. These articles were subsequently screened according to the eligibility criteria, and 20 studies were ultimately included. According to the meta-analysis, in the 20 studies involving 255,057 patients, 181,993 (71.4%) and 73,064 (28.6%) patients received MMA embolization and CM, respectively. MMA embolization performed better than CM in terms of treatment failure (relative risk [RR]\u2009=\u20090.40 [0.18\u20130.87],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.007), recurrence rate (RR\u2009=\u20090.43 [0.32\u20130.57],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.15), and complication rate (RR\u2009=\u20090.91 [0.77\u20131.08],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.06). No difference was observed between the two groups for mortality (RR\u2009=\u20090.72 [0.55\u20130.94],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.94), treatment failure rate (RR\u2009=\u20090.40 [0.18\u20130.87],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.007), surgical salvage rate (RR\u2009=\u20090.59 [0.22\u20131.56],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.29), rehospitalization (RR\u2009=\u20090.66 [0.41\u20131.06],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.24), and improvement rate (RR\u2009=\u20091.05 [0.79\u20131.41],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.43).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MMA embolization may lower the failure rate of treatment and cut the demand for surgical salvage without elevating the risk. Therefore, MMA embolization may be considered in the management of CSDH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/myprospero<\/jats:ext-link>\n                      , PROSPERO CRD420251090976.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1941903","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T05:37:35Z","timestamp":1787290655000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Embolizing the middle meningeal artery to treat chronic subdural hematoma: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Kuijia","family":"Duan","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Qujing Central Hospital of Yunnan Province (Qujing First People's Hospital)","place":["Qujing, Yunnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongmei","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Qujing Central Hospital of Yunnan Province (Qujing First People's Hospital)","place":["Qujing, Yunnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jibo","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Qujing Central Hospital of Yunnan Province (Qujing First People's Hospital)","place":["Qujing, Yunnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2176\/jns-nmc.2022-0207","article-title":"Chronic subdural hematoma-evolution of etiology and surgical treatment","volume":"63","author":"Uno","year":"2023","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1890","DOI":"10.1056\/NEJMoa2313472","article-title":"Adjunctive middle meningeal artery embolization for subdural hematoma","volume":"391","author":"Davies","year":"2024","journal-title":"N Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1186\/s12974-017-0881-y","article-title":"Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy","volume":"14","author":"Edlmann","year":"2017","journal-title":"J Neuroinflammation"},{"key":"B4","doi-asserted-by":"publisher","first-page":"176","DOI":"10.3171\/2014.4.Jns131212","article-title":"Twist-drill craniostomy with hollow screws for evacuation of chronic subdural hematoma","volume":"121","author":"Chari","year":"2014","journal-title":"J Neurosurg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.jocn.2021.07.058","article-title":"Efficacy of endoscopic treatment for chronic subdural hematoma surgery","volume":"92","author":"Amano","year":"2021","journal-title":"J Clin Neurosci"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1145","DOI":"10.1016\/j.wneu.2024.10.136","article-title":"Middle meningeal artery embolization for chronic subdural hematoma: a bibliometric analysis","volume":"193","author":"Chaliparambil","year":"2025","journal-title":"World Neurosurg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1016\/j.wneu.2017.02.070","article-title":"Embolization therapy for refractory hemorrhage in patients with chronic subdural hematomas","volume":"101","author":"Kim","year":"2017","journal-title":"World Neurosurg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1016\/j.nec.2016.11.002","article-title":"Chronic subdural hematoma: epidemiology and natural history","volume":"28","author":"Yang","year":"2017","journal-title":"Neurosurg Clin N Am"},{"key":"B9","doi-asserted-by":"publisher","first-page":"402","DOI":"10.2176\/nmc.ra.2016-0337","article-title":"Chronic subdural hematoma in elderly patients: is this disease benign?","volume":"57","author":"Uno","year":"2017","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.11477\/mf.1436101590","article-title":"Epidemiology of chronic subdural hematomas","volume":"39","author":"Karibe","year":"2011","journal-title":"No Shinkei Geka"},{"key":"B11","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.clineuro.2004.09.015","article-title":"Chronic subdural haematoma: surgical treatment and outcome in 1000 cases","volume":"107","author":"Gelabert-Gonz\u00e1lez","year":"2005","journal-title":"Clin Neurol Neurosurg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/j.wneu.2020.06.140","article-title":"Updates in chronic subdural hematoma: epidemiology, etiology, pathogenesis, treatment, and outcome","volume":"141","author":"Feghali","year":"2020","journal-title":"World Neurosurg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"615","DOI":"10.3171\/2009.9.Jns08825","article-title":"Choosing the best operation for chronic subdural hematoma: a decision analysis","volume":"113","author":"Lega","year":"2010","journal-title":"J Neurosurg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"72","DOI":"10.3171\/2010.8.Jns10298","article-title":"Chronic subdural hematoma in the elderly: not a benign disease","volume":"114","author":"Miranda","year":"2011","journal-title":"J Neurosurg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"992","DOI":"10.1148\/radiol.2017170053","article-title":"Middle meningeal artery embolization for chronic subdural hematoma","volume":"286","author":"Ban","year":"2018","journal-title":"Radiology"},{"key":"B16","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1136\/neurintsurg-2021-018327","article-title":"Total 1-year hospital cost of middle meningeal artery embolization compared to surgery for chronic subdural hematomas: a propensity-adjusted analysis","volume":"14","author":"Catapano","year":"2022","journal-title":"J Neurointerv Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1579","DOI":"10.1007\/s00234-025-03632-y","article-title":"Comparative study between surgical drainage alone and adjuvant middle meningeal artery embolization with histoacryl for the treatment and prevention of chronic subdural hematoma recurrence","volume":"67","author":"Bambini Manzato","year":"2025","journal-title":"Neuroradiology"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1404","DOI":"10.1161\/strokeaha.124.050190","article-title":"Standalone middle meningeal artery embolization versus conservative management for nontraumatic subdural hematoma","volume":"56","author":"Chen","year":"2025","journal-title":"Stroke"},{"key":"B19","doi-asserted-by":"publisher","first-page":"110808","DOI":"10.1016\/j.jocn.2024.110808","article-title":"Comparison of adjunctive middle meningeal artery embolization using embosphere particles versus surgical drainage alone for the treatment of chronic subdural hematoma: a prospective study","volume":"128","author":"Duangprasert","year":"2024","journal-title":"J Clin Neurosci"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1901","DOI":"10.1056\/NEJMoa2401201","article-title":"Middle meningeal artery embolization for nonacute subdural hematoma","volume":"391","author":"Liu","year":"2024","journal-title":"N Engl J Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"108252","DOI":"10.1016\/j.clineuro.2024.108252","article-title":"Middle meningeal artery embolization reduces recurrence following surgery for septated chronic subdural hematomas","volume":"240","author":"Martinez-Gutierrez","year":"2024","journal-title":"Clin Neurol Neurosurg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2477","DOI":"10.1097\/scs.0000000000010650","article-title":"Middle meningeal artery embolization reduces the recurrence rate of chronic subdural hematoma: a propensity score matching analysis","volume":"35","author":"Wang","year":"2024","journal-title":"J Craniofac Surg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1093\/neuros\/nyab192","article-title":"Middle meningeal artery embolization versus conventional treatment of chronic subdural hematomas","volume":"89","author":"Enriquez-Marulanda","year":"2021","journal-title":"Neurosurgery"},{"key":"B24","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1080\/02688690701272232","article-title":"Outcomes and recurrence rates in chronic subdural haematoma","volume":"21","author":"Amirjamshidi","year":"2007","journal-title":"Br J Neurosurg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1136\/jnis-2022-019427","article-title":"Volumetric resolution of chronic subdural hematomas treated with surgical evacuation versus middle meningeal artery embolization during immediate, early, and late follow up: propensity-score matched cohorts","volume":"15","author":"Housley","year":"2023","journal-title":"J Neurointerv Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"168","DOI":"10.25259\/sni_208_2023","article-title":"The efficacy of postoperative middle meningeal artery embolization on chronic subdural hematoma\u2014a multicentered randomized controlled trial","volume":"14","author":"Lam","year":"2023","journal-title":"Surg Neurol Int"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1136\/neurintsurg-2020-016048","article-title":"Middle meningeal artery embolization reduces the post-operative recurrence rate of at-risk chronic subdural hematoma","volume":"12","author":"Shotar","year":"2020","journal-title":"J Neurointerv Surg"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1313","DOI":"10.1136\/jnis-2023-020907","article-title":"Standalone middle meningeal artery embolization versus middle meningeal artery embolization with concurrent surgical evacuation for chronic subdural hematomas: a multicenter propensity score matched analysis of clinical and radiographic outcomes","volume":"16","author":"Chen","year":"2024","journal-title":"J Neurointerv Surg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"380","DOI":"10.7461\/jcen.2023.E2023.05.003","article-title":"Safety of middle meningeal artery embolization for treatment of subdural hematoma: a nationwide propensity score matched analysis","volume":"25","author":"McCann","year":"2023","journal-title":"J Cerebrovasc Endovasc Neurosurg"},{"key":"B30","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1136\/neurintsurg-2019-015421","article-title":"Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption","volume":"12","author":"Ng","year":"2020","journal-title":"J Neurointerv Surg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1136\/neurintsurg-2021-017450","article-title":"Efficacy and mid-term outcome of middle meningeal artery embolization with or without burr hole evacuation for chronic subdural hematoma compared with burr hole evacuation alone","volume":"14","author":"Onyinzo","year":"2022","journal-title":"J Neurointerv Surg"},{"key":"B32","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1001\/jama.2025.7583","article-title":"Meningeal embolization for preventing chronic subdural hematoma recurrence after surgery: the EMPROTECT randomized clinical trial","volume":"334","author":"Shotar","year":"2025","journal-title":"JAMA"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1941903\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T05:37:38Z","timestamp":1787290658000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1941903\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":32,"alternative-id":["10.3389\/fsurg.2026.1941903"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1941903","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]},"article-number":"1941903"}}