Middle Meningeal Artery Embolisation Versus Surgical Drainage for Chronic Subdural Haematoma
DOI:
https://doi.org/10.5281/zenodo.22310470Keywords:
Middle meningeal artery embolisation, Chronic subdural haematoma, Recurrence, Surgical drainage, Randomised controlled trialAbstract
Background: Chronic subdural haematoma (cSDH) is increasingly common in older adults and is usually treated by burr-hole
drainage, but recurrence after surgery alone remains substantial. Middle meningeal artery (MMA) embolisation targets the
membrane vasculature sustaining the haematoma. Objective: To review the rationale, trial evidence, safety and cost-effectiveness of MMA embolisation with and without surgical drainage. Methods: Narrative synthesis of retrospective series, meta-analyses, four pivotal randomised trials (EMBOLISE, STEM, MAGIC-MT, EMPROTECT) and consensus guidance. Findings: Adjunctive embolisation reduced treatment failure or recurrence from roughly 11-39% to 4-16% versus surgery or standard care alone, though a high-risk surgical cohort showed a smaller, non-significant benefit. Complication rates were low and similar between arms. Cost-effectiveness data favour selective use in high-recurrence-risk patients over unselected adoption. Conclusions: Adjunctive MMA embolisation meaningfully lowers cSDH recurrence after drainage and is a reasonable standalone option in selected non-operative candidates, but patient selection and cost-effectiveness remain unresolved.
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