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Abstract - Unilateral Biportal Endoscopic Discectomy Versus Percutaneous Endoscopic Lumbar Discectomy For Lumbar Disc Herniation: A Systematic Review And Meta-analysis

Title: Unilateral Biportal Endoscopic Discectomy Versus Percutaneous Endoscopic Lumbar Discectomy For Lumbar Disc Herniation: A Systematic Review And Meta-analysis

Authors: Muhammad Hassan Waseem, Zain ul Abideen, Sania Aimen, Justin Chen, Jamir Pitton Rissardo, Brandon Lucke-Wold

Conference: 2025 CNS Annual Meeting, Los Angeles, CA

Introduction

Unilateral biportal endoscopic discectomy (UBED) represents a cutting-edge, minimally invasive approach to treating lumbar disc herniation (LDH). Nonetheless, the effectiveness and safety of UBED in relation to traditional percutaneous endoscopic lumbar discectomy (PELD) have yet to be established.

Objective

This study conducted a meta-analysis to compare UBED with PELD for LDH.

Methods

Relevant cohort studies and clinical trials were found by searching PubMed, Cochrane Central, and ScienceDirect from inception till May 2025. Mean differences (MD) and Risk Ratios (RR) were pooled using the random effects model in Review Manager. Outcomes analyzed were operative time, length of hospitalization, visual analogue scale (VAS) for leg and back, Oswestry disability index (ODI), perioperative complications, and LDH recurrence.

Results

This meta-analysis included 23 studies. Pooled results showed that, compared with PELD, UBED was associated with a longer surgery time (MD = 12.91 min; 95% CI: [7.71, 18.12]; p < 0.00001; I2 = 91%) and hospital stay (MD= 1.21 day; 95%CI:[0.44,1.97]; p=0.002; I2= 95%). However, UBED and PELD showed comparative efficacies in improving the VAS of leg (MD= 0.02; 95%CI:[-0.12,0.17]; p=0.73; I2=21%) and back (MD= 0.09; 95%CI:[-0.07,0.26]; p=0.28; I2= 40%), and Oswestry Disability Index (MD= 0.44; 95%CI:[-1.03,1.90]; p=0.56; I2= 78%), scores. The incidence of perioperative complications was not significantly different between the two techniques (RR= 1.09; 95%CI:[0.74,1.62]; p=0.66; I2= 0%), while UBED was associated with a lower LDH recurrence during follow-up (RR= 0.31; 95%CI:[0.14,0.68]; p=0.003; I2=0%).

Conclusions

While UBED resulted in longer surgery and hospital stays, it demonstrated comparable effectiveness to PELD in relieving pain and improving functional capacity in patients with LDH. Additionally, UBED was associated with a lower recurrence of LDH compared to PELD, with no difference in the rate of perioperative complications. These results support UBED as a viable treatment option for patients with LDH.

Citation

Waseem MH, Abideen Z, Aimen S, Chen J, Pitton Rissardo J, Lucke-Wold B. Unilateral Biportal Endoscopic Discectomy Versus Percutaneous Endoscopic Lumbar Discectomy For Lumbar Disc Herniation: A Systematic Review And Meta-analysis. CNS Annual Meeting 2025;2025:5832. https://www.cns.org/poster-search?id=5832

Figure. Forest plots comparing UBED and PELD for lumbar disc herniation: operative time and length of hospitalization.

Figure. Forest plots comparing UBE and PELD for lumbar disc herniation: Visual Analogue Scale (leg, back) and Oswestry Disability Index outcomes.

Figure. Forest plots comparing UBED and PELD for lumbar disc herniation: perioperative complications and recurrence rates with pooled risk ratios and heterogeneity statistics.

Abstract - Unilateral Biportal Endoscopic Discectomy Versus Microdiscectomy For Lumbar Disc Herniation: A Systematic Review And Meta-analysis

Title: Unilateral Biportal Endoscopic Discectomy Versus Microdiscectomy For Lumbar Disc Herniation: A Systematic Review And Meta-analysis

Authors: Muhammad Hassan Waseem, Zain ul Abideen, Sania Aimen, Justin Chen, Jamir Pitton Rissardo, Brandon Lucke-Wold

Conference: 2025 CNS Annual Meeting, Los Angeles, CA

Introduction

Lumbar disc herniation (LDH) is a prevalent spinal condition that leads to considerable disability, frequently necessitating minimally invasive surgical treatment such as Unilateral biportal endoscopic discectomy (UBED) and Microdiscectomy (MD).

Objective

This study aimed to compare the efficacy and safety of UBED versus MD for the treatment of LDH.

Methods

A literature search was conducted across PubMed, Cochrane Library, and ScienceDirect from inception to May 2025. This study evaluated the Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI), MacNab scores, operative time, estimated blood loss, and length of hospitalization at various follow-up durations. The meta-analysis was performed using RevMan 5.4.1 software.

Results

The meta-analysis included 13 studies. The VAS scores for low back pain showed no significant differences between the two groups at postoperative 1–3 months (p = 0.06); however, the UBED group had lower VAS scores at postoperative 1–3 days (MD= -0.81; 95%CI:[-1.48,-0.14];p=0.02; I2= 95%) and 12-months (MD= -0.38; 95%CI:[-0.70,-0.06];p=0.02; I2= 47%). There were no significant differences in leg pain VAS scores at postoperative days 1–3 (p = 0.24), 1–3 months (p = 0.74), or at the 12-month follow-up (p = 0.49). ODI comparisons also revealed no significant differences at the postoperative 1-week (p = 0.47) and 1–3-month (p = 0.21) follow-ups, as well as at the final 12-month follow-up. The UBED group also exhibited a longer mean operative time (MD= 11.12 min; 95%CI:[3.45,18.79];p=0.005; I2= 93%), but significantly shorter hospital stay (MD= -1.47 days; 95%CI:[-2.50,-0.44];p=0.005; I2= 98%) and less estimated blood loss (MD= -74.42 ml; 95%CI:[-114.1,-34.73];p=0.0002; I2= 99%). MacNab scores also showed no significant differences between the two arms (p = 0.10).

Conclusions

The UBED group experienced significantly lower early postoperative pain at 1–3 days and sustained improvement at 12 months compared to MD. Additionally, it showed reduced blood loss and shorter hospital stays along with longer operative times.

Citation

Waseem MH, Abideen Z, Aimen S, Chen J, Pitton Rissardo J, Lucke-Wold B. Unilateral Biportal Endoscopic Discectomy Versus Microdiscectomy For Lumbar Disc Herniation: A Systematic Review And Meta-analysis. CNS Annual Meeting 2025;2025:5719. https://www.cns.org/poster-search?id=5719

Figure. Forest plots comparing VAS back pain scores for UBED vs. MD at 1–3 days, 1–3 months, and 12 months postoperatively.

Figure. Forest plots comparing VAS leg pain scores for UBED vs. MD at 1–3 days, 1–3 months, and 12 months postoperatively.

Figure. Forest plots comparing ODI scores for UBED vs. MD at 1–3 days, 1–3 months, and 12 months postoperatively.

Figure. Forest plots comparing UBED vs. MD for operative time, estimated blood loss, hospitalization length, and MacNab score.

Abstract - Rapid Versus Gradual Weaning of External Ventricular Drain after Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis of Randomized and Non-Randomized Studies

Title: Rapid Versus Gradual Weaning of External Ventricular Drain after Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis of Randomized and Non-Randomized Studies

Authors: Muhammad Hassan Waseem, Zain ul Abideen, Sania Aimen, Justin Chen, Jamir Pitton Rissardo, Brandon Lucke-Wold

Conference: 2025 CNS Annual Meeting, Los Angeles, CA

Introduction

An external ventricular drain (EVD) insertion is among the most frequently performed neurosurgical procedures. It remains unclear whether the weaning method, either gradual or rapid, influences the rate of ventriculoperitoneal shunt (VPS) insertions.

Objectives

This study aims to systematically review the literature comparing gradual and rapid EVD weaning in relation to the VPS insertion rate.

Methods

PubMed, Cochrane Central, and ScienceDirect were searched from inception till May 2025. The Randomized controlled trials and cohort studies comparing gradual and rapid EVD weaning in patients with subarachnoid hemorrhage (SAH) were included in this analysis. The primary outcome was the rate of VPS insertion, while secondary outcomes included the rate of EVD-associated infections and the duration of hospital and ICU stays. The quality assessment was conducted using the Cochrane risk of bias (RoB 2.0) tool and the Newcastle-Ottawa Scale. Publication bias was assessed visually through the funnel plots and statistically through Egger’s regression test.

Results

Five studies, pooling a total of 1,744 patients, were included in this meta-analysis. The VPS insertion rate was low in the rapid EDV weaning, but the results were statistically insignificant (RR = 0.86; 95% CI: [0.59, 1.27]; p = 0.46; I2 = 81%). Similarly, the EVD-associated infections were comparable between the two groups (RR= 0.83;95%CI:[0.50,1.40];p=0.49; I2=51%). However, the length of ICU (MD = -2.94 days; 95% CI: [-3.80, -2.08]; p < 0.00001; I2 = 0%) and hospital (MD = -4.55 days; 95% CI: [-7.14, -1.95]; p = 0.0006; I2 = 62%) stays were significantly shorter in the rapid EVD weaning group.

Conclusions

Rapid EVD weaning was comparable to gradual EVD weaning in terms of VPS insertion rates and EVD-related infections, but it significantly shortens the duration of hospital and ICU stays.

Citation

Waseem MH, Abideen Z, Aimen S, Chen J, Pitton Rissardo J, Lucke-Wold B. Rapid Versus Gradual Weaning of External Ventricular Drain after Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis of Randomized and Non-Randomized Studies. CNS Annual Meeting 2025;2025:6913. https://www.cns.org/poster-search?id=6913

Figure. Forest plot comparing rapid versus gradual external ventricular drain weaning after subarachnoid hemorrhage across randomized and non-randomized studies.

Abstract - Endoscopic Third Ventriculostomy And Choroid Plexus Cauterization Versus Ventriculoperitoneal Shunt In Treatment Of Pediatric Hydrocephalus: A Systematic Review And Meta-analysis

Title: Endoscopic Third Ventriculostomy And Choroid Plexus Cauterization Versus Ventriculoperitoneal Shunt In Treatment Of Pediatric Hydrocephalus: A Systematic Review And Meta-analysis

Authors: Muhammad Hassan Waseem, Zain ul Abideen, Sania Aimen, Justin Chen, Jamir Pitton Rissardo, Brandon Lucke-Wold

Conference: 2025 CNS Annual Meeting, Los Angeles, CA

Introduction

Endoscopic third ventriculostomy with choroid plexus cauterization (EVT/CPC) and ventriculoperitoneal shunt (VPS) are common surgical procedures to treat pediatric hydrocephalus. The combined EVT/CPC has emerged as an effective alternative to VPS.

Objectives

This study aims to compare the efficacy and safety of combined ETV and CPC with VPS for pediatric hydrocephalus treatment.

Methods

PubMed, ScienceDirect, and the Cochrane Library were searched from inception till October 2024. The PRISMA guidelines were followed. The Risk Ratios (RRs) with 95% Confidence interval (CI) were pooled under the random effects model using the Review Manager 5.4.1 for the dichotomous outcomes. The primary outcome was success rate. Secondary endpoints were postoperative complications, infections, mortality, reoperation, and failure rate. The quality of studies was assessed through the Newcastle Ottawa Scale and the Cochrane RoB 2.0 tool. The Leave-one-out sensitivity analysis was performed to investigate the cause of heterogeneity. Publication bias was assessed visually through funnel plots and statistically through Egger’s regression test.

Results

Eight studies, including 604 patients, were included in this meta-analysis. The success rate was comparable between the ETV/CPC and VPS groups (RR= 0.96; 95%CI: [0.86,1.08]; p=0.53; I2=22%). The postoperative complications rate (RR= 0.67; 95%CI: [0.44,1.03]; p= 0.07; I2=0%) and the failure rate (RR=0.91; 95%CI: [0.48,1.71]; p=0.77; I2=61%) decreased in the EVT/CPC group but the results were statistically insignificant. Other outcomes including infections (RR=0.58; 95%CI:[0.24,1.40]; p=0.23; I2=14%), mortality (RR= 1.14; 95%CI:[0.47,2.73]; p= 0.77; I2= 0%), and reoperation rate (RR= 0.71; 95%CI:[0.14,3.75]; p= 0.69; I2=76%) were also comparable between the 2 arms.

Conclusions

Endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) shows a comparable success rate to ventriculoperitoneal shunt (VPS) in treating pediatric hydrocephalus, with no significant differences in postoperative complications, infections, mortality, or reoperation rates. Despite slight reductions in complications and failure rate with ETV/CPC, these findings were not statistically significant.

Citation

Waseem MH, Abideen Z, Aimen S, Chen J, Pitton Rissardo J, Lucke-Wold B. Endoscopic Third Ventriculostomy And Choroid Plexus Cauterization Versus Ventriculoperitoneal Shunt In Treatment Of Pediatric Hydrocephalus: A Systematic Review And Meta-analysis. CNS Annual Meeting 2025;2025:6585. https://www.cns.org/poster-search?id=6585

Figure. Forest plots comparing ETV+CPC and VP shunt in pediatric hydrocephalus for success rate, postoperative complications, and infection outcomes.

Figure. Forest plots comparing ETV+CPC and VP shunt in pediatric hydrocephalus for mortality, reoperation, and failure rates.

Abstract - Efficacy And Safety Of Endovascular Treatment Versus Best Medical Management For Isolated Posterior Cerebral Artery Occlusion: A Systematic Review And Meta-analysis

Title: Efficacy And Safety Of Endovascular Treatment Versus Best Medical Management For Isolated Posterior Cerebral Artery Occlusion: A Systematic Review And Meta-analysis

Authors: Muhammad Hassan Waseem, Zain ul Abideen, Sania Aimen, Justin Chen, Jamir Pitton Rissardo, Brandon Lucke-Wold

Conference: 2025 CNS Annual Meeting, Los Angeles, CA

Introduction

Many key Randomized clinical trials (RCTs) for Endovascular thrombectomy (EVT) in ischemic stroke included limited cases of isolated posterior cerebral artery occlusions (iPCAO), making the benefits of EVT in this population unclear.

Objective

This study aims to analyze the efficacy and safety of EVT in iPCAO.

Methods

PubMed, ScienceDirect, and the Cochrane Library were searched from inception till October 2024. Risk Ratios (RR) with 95 % CI were pooled under the random effects model using Review Manager 5.4.1 for the dichotomous outcomes. The primary outcome was an early neurological improvement (NIHSS ≥2). The secondary endpoints were visual field normalization, favourable functional outcome (mRS 0-2) at 3 months, excellent functional outcomes (mRS 0-1) at 3 months, symptomatic intracranial hemorrhage (sICH), and mortality. Quality assessment was done through the Newcastle Ottawa Scale. To investigate the heterogeneity a sensitivity analysis was performed. Publication bias was assessed visually through the funnel plots and statistically through Egger’s regression test.

Results

Ten studies encompassing 38,655 patients were included in this meta-analysis. EVT significantly increased the early neurological improvement compared to best medical management (BMM) (RR= 1.42; 95%CI: [1.32,1.54]; p<0.00001; I2= 0%). EVT also significantly increased the risk of sICH in iPCAO with an RR of 2 (95%CI: [1.07,3.71]; p=0.03; I2=46%). Other outcomes including favourable functional outcome (mRS 0-2) at 3 months (RR=0.92; 95%CI: [0.84,1.00]; p=0.05; I2=51%), visual field normalization (RR=1.44; 95%CI:[0.96,2.15]; p=0.08; I2=68%), excellent functional outcome (mRS 0-1) at 3 months (RR=1.05; 95%CI:[0.95,1.15]; p=0.36; I2=0%) and mortality at 3 months (RR=1.38; 95%CI:[0.88,2.17]; p=0.16; I2=51%) were comparable between the EVT and BMM.

Conclusions

EVT significantly improves early neurological outcomes in patients with isolated posterior cerebral artery occlusions compared to best medical management, though it also increases the risk of sICH. Other outcomes, including functional recovery and mortality, were similar between EVT and medical management.

Citation

Waseem MH, Abideen Z, Aimen S, Chen J, Pitton Rissardo J, Lucke-Wold B. Efficacy And Safety Of Endovascular Treatment Versus Best Medical Management For Isolated Posterior Cerebral Artery Occlusion: A Systematic Review And Meta-analysis. CNS Annual Meeting 2025;2025:1094. https://www.cns.org/poster-search?id=1094

Figure. Risk ratio of EVT vs BMT for early neurological improvement, visual field normalization, and favourable functional outcome across studies.

Figure. Risk ratio of EVT vs BMT for excellent functional outcome, symptomatic intracranial hemorrhage, and mortality across studies.

Abstract - Early versus Late Cranioplasty Following Decompressive Craniectomy: A Systematic Review and Meta-analysis

Title: Early versus Late Cranioplasty Following Decompressive Craniectomy: A Systematic Review and Meta-analysis

Authors: Muhammad Hassan Waseem, Zain ul Abideen, Sania Aimen, Justin Chen, Jamir Pitton Rissardo, Brandon Lucke-Wold

Conference: 2025 CNS Annual Meeting, Los Angeles, CA

Introduction

Following decompressive craniectomy, a subsequent cranioplasty is required. Complications associated with cranioplasty may arise independent of the initial craniectomy performed.

Objectives

This meta-analysis aims to compare the safety and effectiveness of early versus late cranioplasty following decompressive craniectomy.

Methods

A literature search was performed on PubMed, ScienceDirect, and the Cochrane Library from inception till October 2024. The Risk Ratios (RR) and Mean Differences (MD), along with the 95 % Confidence Interval (CI), were pooled under the random effects model using the Review Manager version 5.4.1 for the dichotomous and continuous outcomes, respectively. The primary outcome was overall complications. The secondary endpoints analyzed were postoperative infections, postoperative subdural fluid collections, mean operative time, and incidence of hydrocephalus. The quality assessment was conducted using the Newcastle-Ottawa Scale (NOS). A sensitivity analysis was performed to investigate the source of heterogeneity. Publication bias was assessed visually through the funnel plots and statistically through Egger’s regression test.

Results

Twenty-one studies, pooling 3,178 patients, were included in this meta-analysis. Early cranioplasty was comparable to late cranioplasty regarding the overall complications (RR= 1.15; 95% CI: [0.86,1.54]; p= 0.35; I2 = 59%), postoperative infections (RR= 0.88; 95% CI: [0.52,1.47]; p=0.62; I2 =0%), and hydrocephalus (RR=1.22; 95% CI: [0.57,2.60]; p=0.60; I2 =74%). Regarding the postoperative subdural fluid collection, the early cranioplasty was significantly superior to the late cranioplasty with an RR of 0.29 (95% CI: [0.11,0.78]; p=0.01; I2 =0%). The mean operative time was also comparable between the two arms (MD= -14.98 min; 95% CI: [-36.98,7.02]; p=0.18; I2 =90%).

Conclusions

Early cranioplasty was comparable to late cranioplasty in terms of overall complications, postoperative infections, hydrocephalus, and mean operative time. The risk of postoperative subdural fluid collection was significantly reduced in early cranioplasty.

Citation

Waseem MH, Abideen Z, Aimen S, Chen J, Pitton Rissardo J, Lucke-Wold B. Early versus Late Cranioplasty Following Decompressive Craniectomy: A Systematic Review and Meta-analysis. CNS Annual Meeting 2025;2025:4327. https://www.cns.org/poster-search?id=4327

Figure. Forest plots comparing risk ratios for overall complications and hydrocephalus between early and late cranioplasty after decompressive craniectomy.

Figure. Forest plots comparing post-operative infections, subdural fluid collection, and operative time between early (EC) and delayed (DC) cranioplasty.

Abstract - Demographic And Regional Trends In Intracranial Injury-Related Mortality In The United States (1999-2020): A Nationwide Retrospective Analysis

Title: Demographic And Regional Trends In Intracranial Injury-Related Mortality In The United States (1999-2020): A Nationwide Retrospective Analysis

Authors: Muhammad Hassan Waseem, Zain ul Abideen, Sania Aimen, Justin Chen, Jamir Pitton Rissardo, Brandon Lucke-Wold

Conference: 2025 CNS Annual Meeting, Los Angeles, CA

Introduction

Intracranial injuries are a significant cause of mortality, with varying rates influenced by demographic and regional factors.

Objectives

This study examines trends in intracranial injury-related deaths among adults in the United States from 1999 to 2020.

Methods

Death certificate data were obtained from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database using the multiple-cause of death MCD-ICD 10 codes (S06.0-S06.9) for patients aged ≥ 25. Crude death rate and age-adjusted mortality rates (AAMR) /100,000 were calculated. Annual percentage changes (APC) along with 95% CIs were analyzed using the Joinpoint regression program and stratified according to age, gender, race, state, and census region.

Results

There were 331,275 intracranial injury-related deaths in the US from 1999-2020. The AAMR showed a slight decrease in mortality from 1999 to 2020 (APC= -0.45, 95% CI: [-0.67, -0.24]. Men had a consistently higher AAMR than women from 1999 (AAMR men: 11.4 vs women: 4.5) to 2020 (AAMR men:10.6 vs women:4.7). On racial analysis, NH American Indian demonstrated the highest AAMR (9.1), followed by Non-Hispanic (NH) white (7.5) and NH blacks (5.8). The highest state-level AAMR was recorded in Wyoming (16.2) and the lowest in New Jersey (4.1). The Midwestern region showed the highest AAMR according to the census region (8.1). Most intracranial injury-related deaths occurred in the medical facility (60.7%).

Conclusions

Intracranial injury-related mortality in the U.S. slightly declined from 1999 to 2020, with men and NH American Indians exhibiting the highest age-adjusted mortality rates. Geographic disparities were evident, with Wyoming and the Midwest reporting the highest rates, and the majority of deaths occurring in medical facilities.

Citation

Waseem MH, Abideen Z, Aimen S, Chen J, Pitton Rissardo J, Lucke-Wold B. Demographic And Regional Trends In Intracranial Injury-Related Mortality In The United States (1999-2020): A Nationwide Retrospective Analysis. CNS Annual Meeting 2025;2025: 4328. https://www.cns.org/poster-search?id= 4328

Figure. Gender-specific intracranial injury-related mortality rates in the United States (1999–2020), illustrating temporal trends and disparities between male and female populations.

Figure. Race-specific intracranial injury-related mortality rates in the United States (1999–2020), highlighting temporal patterns and disparities among racial groups.

Abstract - Comparing Various Surgical Interventions Versus Conservative Medical Treatment In Spontaneous Supratentorial Intracerebral Hemorrhage: A Network Meta-Analysis Of The Randomized Controlled Trials

Title: Comparing Various Surgical Interventions Versus Conservative Medical Treatment In Spontaneous Supratentorial Intracerebral Hemorrhage: A Network Meta-Analysis Of The Randomized Controlled Trials

Authors: Muhammad Hassan Waseem, Zain ul Abideen, Areeba Shoaib , Sania Aimen, Justin Chen, Jamir Pitton Rissardo, Brandon Lucke-Wold

Conference: 2025 CNS Annual Meeting, Los Angeles, CA

Introduction

Spontaneous supratentorial intracerebral hemorrhage (SSICH) poses serious risks of complications and death. Various surgical techniques have been used, but their effectiveness remains unclear.

Objective

This network meta-analysis aims to compare the efficacy and safety of various surgical interventions used in SSICH and to rank them.

Methods

Databases including PubMed, Cochrane Central, and ScienceDirect were searched from inception till February 2025 for Randomized controlled trials (RCTs) investigating neuroendoscopy (NE), stereotactic aspiration (SA), craniopuncture surgery (CP), craniotomy (CR), decompressive craniectomy (DC), and conservative medical treatment (CMT). A frequentist network meta-analysis was conducted using R version 4.2.1 and the “netmeta” package, employing the random effects model. Treatment ranking was performed using p-scores, and the risk of bias was assessed using the ROB 2.0 tool. Publication bias was evaluated via funnel plots and Egger’s Regression test.

Results

The analysis included 25 RCTs with a total of 4,324 patients. Compared to CMT, NE demonstrated a significant improvement in good functional outcome (GFO) with an RR of 1.77 (95% CI: [1.43,2.20]; p<0.0001), while SA (RR=1.65, 95% CI: [1.38,1.98]; p<0.0001) and CR (RR=1.26, 95% CI: [1.04,1.54]; p=0.019) also showed marked improvements. NE was ranked highest for functional improvement, receiving a p-score of 0.93. Additionally, mortality rates were significantly lower for NE (RR=0.67, 95% CI: [0.52,0.85]; p=0.001) and CR (RR=0.82, 95% CI: [0.69,0.98]; p=0.028) compared to CMT. NE was identified as the most effective treatment for mortality reduction with a p-score of 0.81. The risk of rebleeding and overall complications with various surgical interventions was not significantly different compared to CMT

Conclusions

NE, SA, and CR notably enhanced functional outcomes, while NE and CR decreased mortality in patients with SSICH compared to CMT. Based on treatment ranking, NE was the most effective treatment for improving both functional scores and mortality.

Citation

Waseem MH, Abideen Z, Shoaib A, Aimen S, Chen J, Pitton Rissardo J, Lucke-Wold B. Comparing Various Surgical Interventions Versus Conservative Medical Treatment In Spontaneous Supratentorial Intracerebral Hemorrhage: A Network Meta-Analysis Of The Randomized Controlled Trials. CNS Annual Meeting 2025;2025:172. https://www.cns.org/poster-search?id=172

Figure. Forest plots comparing treatments for good functional outcome, mortality, rebleeding, and overall complications using random-effects models with relative risk and 95% confidence intervals.

Figure. Network diagrams showing direct and indirect comparisons among surgical and conservative treatments for four outcomes: functional recovery, mortality, rebleeding, and complications.

Figure. League tables presenting pairwise relative risks and confidence intervals for all interventions across functional outcome, mortality, rebleeding, and complication rates.

Abstract - Comparing Radial Versus Femoral Access For Middle Meningeal Artery Embolization In Patients With Chronic Subdural Hematoma: A Systematic Review And Meta-analysis

Title: Comparing Radial Versus Femoral Access For Middle Meningeal Artery Embolization In Patients With Chronic Subdural Hematoma: A Systematic Review And Meta-analysis

Authors: Muhammad Hassan Waseem, Zain ul Abideen, Sania Aimen, Justin Chen, Jamir Pitton Rissardo, and Brandon Lucke-Wold

Conference: 2025 CNS Annual Meeting, Los Angeles, CA

Introduction

Middle meningeal artery embolization (MMAE) is a growing treatment for chronic subdural hematoma (cSDH) with transradial access (TRA) emerging as a less invasive alternative to traditional transfemoral access (TFA).

Objective

This study aimed to compare the efficacy and safety of TRA versus TFA in MMAE in cSDH.

Methods

We searched PubMed, ScienceDirect, and the Cochrane Library from inception till October 2024. The Risk Ratios (RR) and Mean Difference (MD) were pooled under the random effects model using the Review Manager 5.4.1 for dichotomous and continuous outcomes. The clinically relevant endpoints analyzed were overall complications, access site complications, SDH expansion, procedural success, procedural failure, good functional outcome (mRS ≤ 2), length of hospitalization, and procedural duration. The quality of the studies was assessed by the Newcastle Ottawa Scale. Publication bias was assessed visually through funnel plots and statistically through Egger’s regression test.

Results

Four studies pooling a total of 484 patients were included in this meta-analysis. TRA has a procedural success (RR= 1.00; 95%CI: [0.98,1.03]; p= 0.84; I2=0 %) and failure rate (RR= 0.99; 95%CI: [0.49,2.00]; p= 0.98; I2= 0%) comparable to the TFA. Overall complications were decreased in the TRA, but the results were statistically non-significant (RR= 0.72; 95%CI: [0.41,1.26]; p=0.25; I2= 0%). Other outcomes including access site complications (RR= 0.17; 95%CI:[0.02,1.47]; p=0.11; I2= 0 %), SDH expansion (RR= 1.13; 95%CI:[0.26,4.95]; p=0.87; I2= 0%), good functional outcome (mRS ≤ 2) (RR= 1.01; 95%CI:[0.83,1.22]; p=0.95; I2= 0%), length of hospitalization (MD= 1.01 days; 95%CI:[-0.89,2.91]; p= 0.30; I2= 0%), and procedural duration (MD= 13.92 min; 95%CI:[-46.14,73.97]; p= 0.65; I2= 84%) were also comparable between the 2 access routes.

Conclusions

Radial and Femoral access for MMAE in cSDH demonstrated comparable efficacy and safety across key success rate, failure rate, overall complications, access site complications, SDH expansion, good functional outcome, and procedural duration.

Citation

Waseem MH, Abideen Z, Aimen S, Chen J, Rissardo JP. Lucke-Wold B. Comparing Radial Versus Femoral Access For Middle Meningeal Artery Embolization In Patients With Chronic Subdural Hematoma: A Systematic Review And Meta-analysis. CNS Annual Meeting 2025;2025:5327. https://www.cns.org/poster-search?id=5327

Figure. Forest plots of overall complications, access-site complications, hematoma expansion, and procedural success comparing radial versus femoral access for MMA embolization.

Figure. Forest plots of procedural failure, functional outcome, hospital stay, and procedural duration comparing radial versus femoral access for MMA embolization.