Middle Meningeal Artery Embolization and Adjunctive Pharmacological Therapies for Preventing Recurrence of Chronic Subdural Hematoma: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

This project evaluates the comparative effectiveness and safety of middle meningeal artery embolization and adjunctive pharmacological therapies for chronic subdural hematoma through a systematic review and network meta-analysis of randomized controlled trials. Eligible studies include adults aged 18 years or older with chronic or subacute subdural hematoma. Interventions include middle meningeal artery embolization, corticosteroids, atorvastatin, atorvastatin combined with low-dose dexamethasone, tranexamic acid, Goreisan, Saireito, and angiotensin-converting enzyme inhibitors where eligible evidence is available. Comparators include placebo, standard care, or another eligible intervention. Separate evidence networks are specified for patients undergoing surgical evacuation and those managed without surgery. The primary outcome is recurrence in the postoperative network and hematoma progression or rescue surgery in the nonsurgical network. Secondary outcomes include recurrence requiring reoperation, all-cause mortality, serious adverse events, and favorable functional outcomes. The longest reported follow-up within 12 months is selected. The protocol specifies searches of PubMed, Embase, CENTRAL, Web of Science, CNKI, Wanfang, ClinicalTrials.gov, and WHO ICTRP, without language restrictions. Methods include independent duplicate screening and data extraction, Cochrane RoB 2 assessment, frequentist random-effects network meta-analysis, and assessment of certainty of evidence using CINeMA.