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Background Chronic subdural hematoma (cSDH) is increasingly treated with middle meningeal artery embolization (MMAe), but the impact of technical factors such as degree of penetration and the number of embolized branches remains poorly defined. We sought to perform a systematic review and meta-analysis to determine how these affect outcomes.Methods We performed a PRISMAguided systematic review and metaanalysis of studies reporting on technical factors identified in PubMed, Scopus, Ovid Embase (Elsevier), and the Web of Science. Adults with nonacute subdural hematomas undergoing standalone or adjunct MMAe were included. Outcomes of interest included need for rescue treatment and radiographic success. Random effects models were used to obtain pooled estimates for each outcome.Results A total of 9 studies comprising 858 patients undergoing 1,013 embolizations were included. The mean age was 71.4 years and 31.8% of patients were female. Onyx was the most common embolic agent used. When comparing proximal to distal penetration there was no significant difference in the odds of radiographic success (OR 0.61, 95% CI 0.35 - 1.05; I 2 = 37%; p = 0.08) or rescue treatment (OR 1.83, 95% CI 0.62 - 5.43; I2 = 7.8; p = 0.27). There was also no significant difference in the odds of radiographic success (OR 0.73, 95% CI 0.48 - 1.11; I2 = 15.4%; p = 0.14) or rescue treatment (OR 1.32, 95% CI 0.39 - 4.43; I2 = 45.1%; p = 0.65) when comparing single vs. multiple MMA branches embolized.Conclusion Technical factors of MMAe such as degree of penetration and number of branches embolized were not associated with outcomes in this limited meta-analysis. Multicenter studies with core lab-adjudicated outcomes are needed to investigate this topic further.Disclosures N. Manalil: None. J. Lee: None. J. Collard de Beaufort: None. T. Buddhavarapu: None. K. Sporn: None. H. Polavarapu: None. N. Goyal: None. H. Hoffman: None.