Middle Meningeal Artery Embolization for Chronic Subdural Hematoma in Patients Aged 80 and Older: Systematic Review and Meta Analysis

Introduction: Middle meningeal artery embolization (MMAe) is an emerging procedure, with the advantages of targeting the vascular supply of the neo-membranes implicated in chronic subdural hematoma pathophysiology, however little is known regarding the indications, safety and benefits of MMAe in patients aged 80 years old and older.

Methods: A systematic search was conducted across PubMed, Cochrane, Scopus, and Web of Science databases until October 2024. Analysis was performed using SPSS version 29.0.2.0 to identify factors associated with complete resolution of chronic subdural hematoma (SDH). The model included technical approach and anesthesia type to evaluate complication rates, and antiplatelet therapy, concurrent decompression, hypertension, cardiac disease, history of malignancy, and type of material embolization as predictors of complete resolution.

Results: In 24 studies with 64 patients over 80 years old treated with MMA embolization, no significant differences in complications were found between transradial and transfemoral approaches (OR = 0.429, p = 0.415) or between general anesthesia and conscious sedation (OR = 0.429, p = 0.415).
Complete subdural hematoma resolution was achieved in 39 patients (61%). Antiplatelet therapy was linked to lower odds of SDH resolution (OR = 0.093, p < 0.001), while concurrent decompression increased the odds (OR = 4.829, p = 0.028).
Hypertension (OR = 2.228, p = 0.239), diabetes (OR = 1.310, p = 0.297), cardiac disease (OR = 0.6, p = 0.69), and malignancy history (OR = 1.01, p = 0.842) weren’t significantly associated with SDH resolution. Liquid vs. particle embolization (OR = 0.537, p = 0.414) and particle vs. micro coil embolization (OR = 1.673, p = 0.543) showed no significant differences.

Conclusion : In patients aged 80+ treated with MMAe, hypertension, diabetes, cardiac disease, and malignancy history did not affect cSDH resolution. Concurrent decompression improved resolution, while antiplatelet therapy reduced it. Embolization material and approach (trans-radial or transfemoral) showed no significant impact. Further studies are needed to confirm these findings.