Complications of Middle Meningeal Artery Embolization: A Systematic Review and Meta-Analysis

• Published in: World neurosurgery 2025-01, p.123541, Article 123541
• Main Authors: Shafi, Mahnoor, Badikol, Shrikar R., Gerstl, Jakob V.E., Nawabi, Noah L.A., Sukumaran, Madhav, Kappel, Ari D., Feroze, Abdullah H., Smith, Timothy R., Mekary, Rania A., Aziz-Sultan, Mohammad Ali
• Format: Article
• Language: English
• Subjects: Chronic subdural hematoma; Complications; Middle meningeal artery embolization
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2024.11.124

Middle meningeal artery embolization (MMAE) is an established treatment option for chronic subdural hematoma. The aim of this systematic review and meta-analysis was to establish estimates of the pooled incidence for complications following MMAE. PubMed, Embase, and Cochrane were searched for studies reporting complications following MMAE through January 2023. A random effects model was used to calculate the pooled incidence of complications stratified based on whether studies excluded patients with comorbidities. Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed. A final 34 studies containing 921 patients undergoing MMAE were included that reported 35 complications. Neurological complications were reported in 7 studies with an overall pooled incidence of 3.8% (95% confidence interval [CI]: 2.6%–5.5%). Across these studies, there was a pooled incidence of 4.9% (95% CI: 2.9%–8.0%), 3.0% (95% CI: 1.7%–5.3%), and 2.1% (95% CI: 0.4%–9.7%) in studies that did not exclude, did not mention, or excluded patients with comorbidities, respectively. Similarly, 7 studies reported cardiovascular complications with an overall pooled incidence of 3.6% (95% CI: 2.4%–5.4%), 4 studies reported infectious complications with an overall pooled incidence of 2.9% (95% CI: 1.9%–4.5%), and 3 studies reported for miscellaneous complications with an overall pooled incidence of 3.1% (95% CI: 2.0%–4.8%). Further subgroup analysis revealed the pooled incidence of cardiovascular complications was 3.2% (95% CI: 1.7%–6.1%) in studies that did not exclude patients with comorbidities, 4.1% (95% CI: 2.3%–7.1%) in studies that did not specify the exclusion of such patients, and 1.8% (95% CI: 0.2%–11.5%) in studies that excluded these patients. Similarly, the incidence of infectious complications was 3.3% (95% CI: 1.7%–6.2%), 2.7% (95% CI: 1.5%–5.0%), and 1.8% (95% CI: 0.2%–11.5%) across these groups, respectively. Miscellaneous complications were reported at 4.0% (95% CI: 2.2%–7.2%), 2.3% (95% CI: 1.1%–4.6%), and 3.1% (95% CI: 0.9%–10.1%), respectively. The published literature suggests that MMAE is a generally well-tolerated procedure with a low risk of significant complications.