No Significant Advantage of middle meningeal artery Embolization Over Standard Care in Preventing CSDH Recurrence: JAMA

The rate of CSDH recurrence after 6 months, as determined by an impartial, blinded adjudication committee, was the main outcome measure. The rates of repeat surgery for homolateral CSDH recurrence during the 6-month follow-up period and complications linked to the embolization operation were among the 5 secondary end goals.

The experiment was completed by 308 (90.1%) of the 342 randomized patients (median [IQR] age, 77 [68-83] years; 274 [80.1%] male). In the intervention and control groups, the primary end goal was seen in 24 out of 162 patients (14.8%) and 33 out of 157 patients (21.0%), respectively (after imputation: odds ratio, 0.64 [95% CI, 0.36-1.14]; adjusted absolute difference, −6% [95% CI, −14% to 2%]; P =.13).

None of the secondary end objectives showed a significant difference between the groups. In the intervention group, 7 out of 162 patients (4.3%) and 13 out of 157 patients (8.3%) underwent repeat surgery (P =.14). Three out of 171 patients (1.8%) experienced minor issues from the embolization treatment, whereas one out of 171 patients (0.6%) experienced serious difficulties. Overall, the rate of recurrence at 6 months was not significantly decreased by embolization of the MMA with 300- to 500-μm TAGM in patients with surgically treated CSDH who are at high risk of recurrence. 

Source:

Shotar, E., Mathon, B., Salle, H., Rouchaud, A., Mounayer, C., Bricout, N., Lejeune, J.-P., Janot, K., Amelot, A., Naggara, O., Roux, A., Goutagny, S., Guédon, A., Houdart, E., Brunel, H., Hak, J.-F., Troude, L., Dufour, H., Bernat, A.-L., … EMPROTECT Investigators. (2025). Meningeal embolization for preventing chronic subdural hematoma recurrence after surgery: The EMPROTECT randomized clinical trial: The EMPROTECT randomized clinical trial. JAMA: The Journal of the American Medical Association. https://doi.org/10.1001/jama.2025.7583