Table 2.
Details and outcomes of MMAE.
| Study | No of patients | No of embolizations | Mean follow-up | Embolization material (n) | MMAE alone (%) | Prophylactic MMAE (%) | Upfront-MMAE (%) | Recurrent cSDH (%) | Complications (%) | Resolution (%) | Recurrence (%) | Rescue surgery (%) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Kim et al. (5) | 20 | 20* | 3 months† | PVA (20) | 20 (100) | 0 (0) | 0 (0) | 20 (100) | 0 (0)‡ | 19 (95.0) | 1 (5.0) | 0 (0) |
| Ban et al. (9) | 72 | 72* | 6 months† | PVA (72) | 27 (37.5) | 45 (62.5) | 27 (37.5) | 0 (0) | 0 (0) | NR | 1 (1.4) | 1 (1.4) |
| Waqas et al. (10) | 8 | 8 | 3.3 months | Onyx (8) | 8 (100) | 0 (0) | 6 (75) | 2 (25.0) | 0 (0) | 8 (100) | 0 (0) | 0 (0) |
| Saitoh et al. (11) | 8 | 8* | 28.9 months | NBCA (7) NBCA+PVA (1) | 1 (12.5) | 7 (87.5) | 0 (0) | 8 (100) | 0 (0) | NR | 1 (12.5) | 1 (12.5) |
| Okuma et al. (4) | 17 | 17* | 26.3 months | NBCA (11) Embosphere (3) both (3) coil (1) | 2 (11.8) | 15 (88.2) | 2 (11.8) | 11 (64.7) | 0 (0) | NR | 0 (0) | 0 (0) |
| Nakagawa et al. (12) | 20 | 20* | 24 weeks† | NBCA (20) | 0 (0) | 20 (100) | 0 (0) | 20 (100) | 0 (0) | NR | 0 (0) | 0 (0) |
| Link et al. (13) | 49 | 60 | >6 weeks | PVA (49) | 50 (83.3) | 10 (16.7) | 42 (70.0) | 8 (13.3) | 0 (0) | 41 (91.1) | 4 (8.9) | 4 (8.9) |
| Yajima et al. (14) | 18 | 18* | 18.1 months | NBCA (18) | 2 (11.1) | 16 (88.9) | 2 (11.1) | 15 (83.3) | 0 (0) | NR | 0 (0) | 0 (0) |
| Shotar et al. (15) | 89 | 89* | 3 months† | Microspheres with or without coil (81) coil (5) NBCA (5) | 0 (0) | 89 (100) | 0 (0) | 22 (21.2) | 6 (6.6) | NR | 7 (7.7) | 4 (2.2) |
| Rajah et al. (16) | 46 | 46* | 8 weeks | Onyx (43) NBCA (1) | 42 (91.3) | 4 (8.7) | 37 (80.4) | 5 (10.9) | 0 (0) | 38 (86.5) | 5 (11.4) | 5 (11.4) |
| Ng et al. (17) | 19 | 22 | 3 months | PVA and/or coil (21) | 0 (0) | 22 (100) | 0 (0) | 0 (0) | 0 (0) | NR | 1 (4.5) | 1 (4.5) |
| Mureb et al. (18) | 8 | 8 | 89 days | PVA (8) | 8 (100) | 0 (0) | 8 (100) | 0 (0) | 0 (0) | 8 (100) | 0 (0) | 0 (0) |
| Joyce et al. (19) | 121 | 151 | 90 days† | Coil (6) liquid (30) particles (38) liquid + coil (2) particles + coil (72) particles + liquid (1) | 134 (88.7) | 17 (11.3) | 79 (52.3) | 55 (36.4) | 3 (2.0) | 130 (94.2) | 9 (7.4) | 9 (7.4) |
| Fan et al. (20) | 7 | 7 | 4–6 months | Absolute alcohol (7) | 0 (0) | 7 (100) | 0 (0) | NR | 0 (0) | 7 (100) | 0 (0) | 0 (0) |
| Wei et al. (21) | 10 | 20 | 112 days | Coil (10) | 0 (0) | 20 (100) | 0 (0) | 0 (0) | 0 (0) | NR | 0 (0) | 0 (0) |
| Tiwari et al. (22) | 10 | 13 | 160 days | Embospheres and/or coil/gel-form (8) | 13 (100) | 0 (0) | 7 (53.8) | 6 (46.2) | 0 (0) | 12 (92.3) | 0 (0) | 0 (0) |
| Tanoue et al. (23) | 15 | 15 | 28 days† | NBCA (13) Embosphere (2) | 15 (100) | 0 (0) | 15 (100) | NR | 0 (0) | NR | 3 (20.0) | 3 (20.0) |
| Schwarz et al. (24) | 41 | 44 | 321 days | PVA (44) | 0 (0) | 44 (100) | 0 (0) | NR | 0 (0) | 40 (90.9) | 2 (4.5) | 2 (4.5) |
| Petrov et al. (25) | 10 | 15 | 111 days | Squid (15) | 15 (100) | 0 (0) | 9(60) | 6 (40.0) | 0 (0) | 10 (100) | 0 (0) | 0 (0) |
| Lee et al. (26) | 22 | 31 | >2 weeks | Liquid (11) PVA (9) PVA and coil (11) | 31 (100) | 0 (0) | 28 (90.3) | 3 (13.6) | 1 (3.2) | 15 (48.4) | 2 (6.5) | 2 (6.5) |
| Kan et al. (27) | 138 | 138* | 94.9 days | PVA + coil (70) PVA (38) liquid (37) coil (5) liquid + coil (2) | 138 (100) | 0 (0) | 92 (66.7) | 42 (33.3) | 3 (2.2) | 134 (87.0) | 10 (7.2) | 9 (6.5) |
| Gomez-Paz et al. (28) | 23 | 27 | 3 months | PVA + coil (27) | 27 (100) | 0 (0) | 27 (100) | 0 (0) | 0 (0) | 27 (100) | 1 (3.7) | 3 (11.1) |
| Scovile et al. (29) | 208 | 208 | 6 months† | Particles; PVA, Embosphere (154) liquid; NBCA, Onyx (54) | 192 (92.1) | 16 (7.9) | 133 (63.9) | 59 (28.3) | 11 (5.3)‡ | 126 (60.6) | NR | 10 (4.8) |
| Saway et al. (30) | 100 | 100* | 1.9 months | Onyx (29) Particles (58) particle and coil (13) | 0 (0) | 100 (100) | 0 (0) | 10 (10.0) | 1 (1.0) | 100 (100) | 2 (2.0) | 2 (2.0) |
| Samarage et al. (31) | 37 | 37* | NR | NBCA (38) PVA (9) Onyx (3) combination (17)* | 19 (51.4) | 18 (49) | 19 (51.4) | NR | 3 (8.1) | 18 (48.6) | 5 (13.5) | 5 (13.5) |
| Salie et al. (32) | 52 | 52 | 100 days | Particle coil Liquid combination (NR) | 0 (0) | 52 (100) | 0 (0) | NR | NR | 47 (90.4) | 3 (5.8) | 2 (3.8) |
| Onyinzo et al. (33) | 50 | 50 | 3.4 months | PVA and/or coil (50) | 19 (38.0) | 31 (62.0) | 19 (38.0) | NR | 0 (0) | 13 (59.0) | 1 (4.5) | 1 (4.5) |
| Mir et al. (34) | 56 | 56* | 90 days | PVA and/or coil (NA) Onyx (NA) NBCA (NR) | 56 (100) | 0 (0) | 35 (62.5) | 21 (37.5) | 2 (3.6) | 35 (62.5) | 1 (1.8) | 1 (1.8) |
| Magidi et al. (35) | 61 | 61* | 3 months† | NBCA (61) | 61 (100) | 0 (0) | 31 (50.8) | 30 (49.2) | 2 (3.3) | 59 (96.7) | 3 (4.9) | 2 (3.3) |
| Khorasanizadeh et al. (36) | 78 | 94 | 114 days | PVA and coil (82) coil (12) | 80 (85.1) | 14 (14.9) | 72 (76.6) | 8 (8.5) | 2 (2.1) | 67 (78.8) | 8 (8.5) | 8 (8.5) |
| Housley et al. (37) | 44 | 48 | 12–60 weeks | Onyx (48) | 48 (100) | 0 (0) | 48 (100) | 0 (0) | NR | 38 (79.2) | 2 (4.2) | 2 (4.2) |
| Fuentes et al. (38) | 322 | 322 | 5 years | NR | 322 (100) | 0 (0) | 286 (88.8) | 36 (11.2) | NR | NR | NR | 55 (17.1) |
| Enriquiz-Marulanda et al. (39) | 36 | 45 | 72 days | PVA + coil (43) coil (2) | 35 (77.7) | 10 (22.2) | 35 (77.7) | NR | 1 (2.2) | 28 (71.8) | 1 (2.6) | 5 (11.1) |
| Dofuku et al. (40) | 9 | 9 | 103 days | NBCA (9) | 0 (0) | 9(100) | 0 (0) | 9 (100) | 0 (0) | NR | 0 (0) | 0 (0) |
| Catapano et al. (41) | 66 | 84 | 180 days† | Onyx (66) PVA or coil or both (13) NBCA (5) | 53 (63.1) | 31 (36.9) | 53 (63.1) | NR | 1 (1.2) | 67 (91.8) | 3 (3.6) | 3 (3.6) |
| Carpenter et al. (42) | 23 | 23* | 4.1 months | PVA (23) | 0 (0) | 23 (100) | 0 (0) | NR | 6 (26.0) | NR | 2 (9.1) | 2 (9.1) |
| Wali et al. (43) | 8 | 8 | >3 months | PVA and helical coil (8) | 7 (87.5) | 1 (12.5) | 7 (87.5) | 0 (0) | 0 (0) | 8 (100) | 0 (0) | 0 (0) |
| Shehabeidin et al. (44) | 97 | 97 | 4.2 months (Onyx) 3.0 months (PVA) | Onyx (49) PVA (48) | 48 (53.3) | NR | 48 (53.3) | NR | 0 (0) | NR | 18 (18.6) | 13 (13.4) |
| Seok et al. (45) | 9 | 13 | 4.7 months | PVA and Gelform (8) | 8 (61.5) | 5 (38.5) | 8 (61.5) | 4 (30.8) | 0 (0) | 12 (92.3) | 1 (7.7) | 1 (7.7) |
| Salem et al. (46) | 530 | 636 | 121 days | coil and particles (248) liquid (228) | 468 (74.3) | 162 (25.8) | 318 (50.4) | 150 (23.9) | 16 (3.0) ‡ | 490 (87.5) | 36 (6.8) | 36 (6.8) |
| Martinez-Gutierrez et al. (47) | 57 | 66 | 20 days | Particles (NR) coil (NR) Onyx (NR) | 66 (100) | 0 (0) | 25 (37.9) | 41 (62.1) | NR | NR | 11 (16.7) | 4 (6.1) |
| Liu et al. (48) | 53 | 53 | 6 months† | PVA and NBCA (53) | 31 (58.5) | 22 (41.5) | 31 (58.5) | NR | NR | 48 (90.6) | 1 (2.4) | 0 (0) |
| Krothapalli et al. (49) | 116 | 116 | 29 days (liquid) 35 days (particles) | NBCA (48) PVA (68) | 68 (58.6) | 48 (41.4) | 68 (58.6) | NR | 1 (0.9) | NR | 6 (5.2) | 2 (1.7) |
| 2,783 | 3,027 | 2,114 (69.8) | 907 (31.0) | 1,617 (53.4) | 591 (24.6) | 58 (2.4) | 1,645 (83.8) | 155 (6.2) | 197 (6.4) |
NR, not reported; MMAE, middle meningeal artery embolization; cSDH, chronic subdural hematoma; PVA, polyvinyl alcohol; NBCA, N-butyl cyanoacrylate. *Treatment of bilateral cSDH counted as one treatment. †Follow-up period was set as the evaluation period in the study. ‡Complications with unknown details or unknown association with MMAE were not counted.