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

A new study published in the Journal of American Medical Association showed that middle meningeal artery (MMA) embolization did not significantly reduce recurrence rates of chronic subdural hematoma (CSDH) at 6 months compared to standard medical care. However, the effect size aligns with previous studies suggesting potential benefits, indicating a need for further research into this treatment approach.

One possible therapy for chronic subdural hematoma is middle meningeal artery embolization. Thus, to determine if MMA embolization is more effective than standard treatment in lowering the chance of CSDH recurrence at 6 months in patients who had surgery and were at high risk of recurrence, this research was carried out.

This clinical study from July 2020 to March 2023, was at 12 French neurosurgical or comprehensive neurosurgical and interventional neuroradiology institutions recruited patients who had surgery for CSDH recurrence or a first CSDH episode at high risk of recurrence. Within 7 days following surgery, the participants were randomly assigned to receive either normal medical treatment alone (171 patients, control group) or MMA embolization with microparticles (171 patients, intervention group).

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