LAUSR

INTRODUCTION: Middle meningeal artery (MMA) embolization is increasing in popularity and is thought to lower the rate of subdural hematoma recurrence and need for surgical rescue. Multiple embolic agents have been utilized, but the most effective agent has not been identified. METHODS: Clinical outcomes of embolization using polyvinyl alcohol (PVA) with or without (+/-) coils, N-butyl cyanoacrylate (n-BCA) +/- coils, and Onyx alone were separately evaluated. Outcome measures were the need for surgical rescue and in hospital periprocedural complications. RESULTS: 30 studies were identified with a total of 646 patients, with 449 receiving PVA +/- coils, 134 receiving n-BCA +/- coils, and 60 patients receiving onyx alone. Composite rates for need for surgical rescue following embolization were 4.6% (95% Confidence Interval: 2.5% to 6.7%) for PVA +/- coils, 3.7% (CI: 0.6% to 6.8%) for n-BCA +/- coils, and 9.0% (CI: 1.9% to 5.4%) for Onyx alone. However, meta-regression revealed no significant difference between n-BCA and PVA based embolization (P = 0.728), between n-BCA and Onyx alone (P = 0.177), nor between PVA based and Onyx (P = 0.323) concerning need for surgical rescue. In regard to periprocedural complication rates, there was a pooled composite rate of 1.5% (CI: 0.3% to 2.7%) for PVA +/- coils, 3.1% (CI: 0.2% to 6.1%) for n-BCA +/- coils, and 2.7% (CI: 0% to 6.7%) for Onyx embolization. Similarly, meta-regression indicated no significant difference between PVA and n-BCA based therapy (P = 0.318), between n-BCA and Onyx embolization (P = 0.869), nor between PVA based and Onyx (P = 0.574). CONCLUSIONS: Rates of periprocedural complications and need for surgical rescue following MMA embolization are not influenced by the type of embolic agent utilized.