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Peer-reviewedCC BY 4.0Frontiers in Neurology

Comparative outcomes of middle meningeal artery embolization, burr hole drainage, and neuroendoscopic-assisted evacuation with MMA disconnection for chronic subdural haematoma: a multicenter retrospective cohort study

  • Xudong Song1
  • Yuan Zhang1
  • Bo Luo1
  • Xiyuan Tang2
  1. 1Department of Neurosurgery, Capital Medical University Affiliated Beijing Anzhen Hospital Nanchong Hospital
  2. 2Department of Neurosurgery, Guangyuan Central Hospital
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Abstract

Objective: To compare the efficacy, safety, and resource utilization of middle meningeal artery embolization (MMAE), burr hole drainage (BHD), and neuroendoscopic-assisted evacuation with middle meningeal artery disconnection (NE-MMAD) for chronic subdural haematoma (CSDH).

Methods: A retrospective analysis was performed on 265 patients with CSDH, divided into MMAE ( n = 46), BHD ( n = 152), and NE-MMAD ( n = 67) groups. The primary outcome was the 6-month recurrence rate. Secondary outcomes included neurological improvement rate, reoperation rate, operation time, hospital stay, number of imaging follow-ups, and complications.

Results: The recurrence rates for MMAE and NE-MMAD (4.35 and 4.48%, respectively) were significantly lower than that for BHD (19.74%, p = 0.001). The neurological improvement rate was highest in the NE-MMAD group (88.06%, p = 0.003). The reoperation rates for MMAE and NE-MMAD were both lower than that for BHD ( p = 0.002). In the MMAE group, 5 patients (10.87%) underwent salvage BHD due to delayed resolution of mass effect. MMAE had the shortest operation time (31 min) and hospital stay (7 days), while NE-MMAD had the longest operation time (70 min); both MMAE and NE-MMAD required fewer imaging follow-ups than BHD (all p < 0.05). No significant difference in complication rates was observed among the three groups; however, one patient in the MMAE group experienced permanent blindness due to inadvertent embolization through a dangerous anastomosis.

Conclusion: In this cohort, MMAE and NE-MMAD were associated with lower recurrence compared with BHD, and NE-MMAD was associated with the greatest neurological improvement. BHD may be preferred for first-onset, non-septated haematomas; MMAE may be preferred for older patients or those with coagulopathy, but the risk of blindness warrants caution; NE-MMAD may be preferred for septated, organized, recurrent, and markedly space-occupying haematomas. Clinical decision-making should integrate haematoma characteristics, patient status, and available medical resources to guide individualized stratified treatment.

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Cite

BibTeXRIS
BibTeX
@article{song2026comparative,
  title = {{Comparative outcomes of middle meningeal artery embolization, burr hole drainage, and neuroendoscopic-assisted evacuation with MMA disconnection for chronic subdural haematoma: a multicenter retrospective cohort study}},
  author = {Xudong Song and Yuan Zhang and Bo Luo and Xiyuan Tang},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1975364},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1975364/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Comparative outcomes of middle meningeal artery embolization, burr hole drainage, and neuroendoscopic-assisted evacuation with MMA disconnection for chronic subdural haematoma: a multicenter retrospective cohort study
AU  - Xudong Song
AU  - Yuan Zhang
AU  - Bo Luo
AU  - Xiyuan Tang
PY  - 2026
DA  - 2026/10/19
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1975364
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1975364/full
AB  - Objective: To compare the efficacy, safety, and resource utilization of middle meningeal artery embolization (MMAE), burr hole drainage (BHD), and neuroendoscopic-assisted evacuation with middle meningeal artery disconnection (NE-MMAD) for chronic subdural haematoma (CSDH).  Methods: A retrospective analysis was performed on 265 patients with CSDH, divided into MMAE ( n = 46), BHD ( n = 152), and NE-MMAD ( n = 67) groups. The primary outcome was the 6-month recurrence rate. Secondary outcomes included neurological improvement rate, reoperation rate, operation time, hospital stay, number of imaging follow-ups, and complications.  Results: The recurrence rates for MMAE and NE-MMAD (4.35 and 4.48%, respectively) were significantly lower than that for BHD (19.74%, p = 0.001). The neurological improvement rate was highest in the NE-MMAD group (88.06%, p = 0.003). The reoperation rates for MMAE and NE-MMAD were both lower than that for BHD ( p = 0.002). In the MMAE group, 5 patients (10.87%) underwent salvage BHD due to delayed resolution of mass effect. MMAE had the shortest operation time (31 min) and hospital stay (7 days), while NE-MMAD had the longest operation time (70 min); both MMAE and NE-MMAD required fewer imaging follow-ups than BHD (all p < 0.05). No significant difference in complication rates was observed among the three groups; however, one patient in the MMAE group experienced permanent blindness due to inadvertent embolization through a dangerous anastomosis.  Conclusion: In this cohort, MMAE and NE-MMAD were associated with lower recurrence compared with BHD, and NE-MMAD was associated with the greatest neurological improvement. BHD may be preferred for first-onset, non-septated haematomas; MMAE may be preferred for older patients or those with coagulopathy, but the risk of blindness warrants caution; NE-MMAD may be preferred for septated, organized, recurrent, and markedly space-occupying haematomas. Clinical decision-making should integrate haematoma characteristics, patient status, and available medical resources to guide individualized stratified treatment.
SN  - 1664-2295
ER  -