Safety and Efficacy of Middle Meningeal Artery Aneurysm and Pseudoaneurysm Embolization: A Systematic Review

BACKGROUND: Middle meningeal artery embolization (MMAE) is increasingly used to treat chronic subdural hematomas, arteriovenous fistulas, and meningiomas. Less commonly, MMAE is performed for pseudoaneurysms and aneurysms of the middle meningeal artery (MMA). While procedural safety and efficacy in the context of the former diseases is well know, data on MMA embolization for MMA aneurysms and pseudo-aneurysms are scarce. PURPOSE: The purpose of this study was to systematically review the safety, efficacy, and procedural details of MMAE for pseudoaneurysms and aneurysms. DATA SOURCE: We conducted a systematic review using PubMed/Medline and GoogleScholar, targeting studies published in English since 1994. STUDY SELECTION: Original research studies and case reports involving adult patients (18 years of age or older) with pseudoaneurysms and aneurysms treated with MMAE were included. Data on disease etiology, complications, outcomes, procedural techniques, and embolization materials were analyzed using descriptive statistics. DATA SYNTHESIS: Of 1690 identified studies, 600 underwent full-text review, and 28 studies/case reports focusing on MMAE for pseudoaneurysms and aneurysms were included in the final analysis. The treated cases were mainly traumatic (54.84%, 17/31), followed by tumor-related (16.13%, 5/31), iatrogenic (12.90%/4/31), miscellaneous (9.68% 3/31), and mycotic (3.2.3%, 1/31) etiologies. The most used embolization materials were coils (38.71%, 12/31), n-BCA (29.03%, 9/31), ethylene-vinyl alcohol copolymer (EVOH, Onyx) (19.35%, 6/31), and polyvinyl alcohol (9.68%, 3/31). Complete occlusion of the aneurysm or pseudoaneurysm was achieved in all cases. Symptom improvement related to MMAE occurred in 28 of 31 patients (90.32%). If symptoms remained, they were mild, such as mild hemiparesis (n = 3). Complications of MMAE occurred in 1 case, namely nontarget embolization of middle cerebral artery branches due to occult anastomoses between the MMA and middle cerebral artery related to prior trauma; however, the patient experienced no permanent deficits. LIMITATIONS: Available data on MMAE for MMA aneurysms and pseudoaneurysms are scarce and from case reports only, limiting generalizability. Confirmation in larger, multicenter cohort studies is needed. CONCLUSION: MMAE appears to be a safe and effective treatment for pseudoaneurysms and aneurysms, with minimal complications and high angiographic success rates.