{"title":"Middle meningeal artery embolization versus conventional management for patients with chronic subdural hematoma: An umbrella review","authors":"Pemla Jagtiani , Mert Karabacak , Paritosh Coomar , Konstantinos Margetis","doi":"10.1016/j.clineuro.2024.108572","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and objectives</h3><div>Conventional surgical modalities, including twist drill craniotomy, burr hole evacuation, and craniotomy, are the standard surgical interventions for chronic subdural hematomas (cSDH). More recently, treatment of cSDH with middle meningeal artery embolization (MMAE) is being explored. The comparative effectiveness of MMAE versus conventional surgical modalities remains controversial. The objective of this study is to analyze various postoperative outcomes in an umbrella review of existing meta-analysis comparing MMAE and conventional management in patients with cSDH.</div></div><div><h3>Methods</h3><div>A systematic literature search was executed with defined criteria across PubMed, Scopus, and Web of Science databases. Data was analyzed utilizing the <em>metaumbrella</em> R package, employing equivalent Hedges’ g values. The quality assessment of each meta-analysis was carried out using AMSTAR2, assigning scores within the range of 0–11. The credibility of the evidence was determined by applying the Ioannidis criteria.</div></div><div><h3>Results</h3><div>This umbrella review study included five meta-analyses. Upon pooling the meta-analyses, MMAE was associated with fewer reoperations and recurrence, supported by a weak level of evidence (class IV). Conversely, findings related to other postoperative outcomes did not reach statistical significance.</div></div><div><h3>Conclusion</h3><div>Our umbrella review offers a comprehensive summary investigating MMAE and conventional management for the treatment of cSDH. MMAE had fewer reoperations and recurrence, but they were classified as being of weak significance. These findings underscore insufficient evidence within the existing literature, emphasizing the imperative need for additional research in this area.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Neurology and Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0303846724004591","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and objectives
Conventional surgical modalities, including twist drill craniotomy, burr hole evacuation, and craniotomy, are the standard surgical interventions for chronic subdural hematomas (cSDH). More recently, treatment of cSDH with middle meningeal artery embolization (MMAE) is being explored. The comparative effectiveness of MMAE versus conventional surgical modalities remains controversial. The objective of this study is to analyze various postoperative outcomes in an umbrella review of existing meta-analysis comparing MMAE and conventional management in patients with cSDH.
Methods
A systematic literature search was executed with defined criteria across PubMed, Scopus, and Web of Science databases. Data was analyzed utilizing the metaumbrella R package, employing equivalent Hedges’ g values. The quality assessment of each meta-analysis was carried out using AMSTAR2, assigning scores within the range of 0–11. The credibility of the evidence was determined by applying the Ioannidis criteria.
Results
This umbrella review study included five meta-analyses. Upon pooling the meta-analyses, MMAE was associated with fewer reoperations and recurrence, supported by a weak level of evidence (class IV). Conversely, findings related to other postoperative outcomes did not reach statistical significance.
Conclusion
Our umbrella review offers a comprehensive summary investigating MMAE and conventional management for the treatment of cSDH. MMAE had fewer reoperations and recurrence, but they were classified as being of weak significance. These findings underscore insufficient evidence within the existing literature, emphasizing the imperative need for additional research in this area.
期刊介绍:
Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.