Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
World Neurosurg. 2019 Jun;126:228-236. doi: 10.1016/j.wneu.2019.02.208. Epub 2019 Mar 13.
Embolization of the middle meningeal artery (MMA) has emerged as a minimally invasive means of managing subdural hematoma. The purpose of this study was to systematically review the literature on the safety and effectiveness of this treatment and to share our clinical experience.
This review was registered with PROSPERO. PubMed, CINAHL, EMBASE, and the Cochrane Library were searched using MeSH (Medical Subject Headings) terms for MMA embolization and chronic subdural hematoma (CSDH) from January 2000 to November 2018. All articles in the English language literature describing MMA embolization for CSDH were included, irrespective of study design. Consecutive patients who underwent MMA embolization at our hospital between January 2017 and June 2018 comprised our clinical experience.
Fifteen studies with 193 procedures were included in the review. Ninety-five cases (49.2%) involved primary MMA embolization; 88 embolizations (45.6%) for recurrent CSDH and 10 (5.2%) for prophylaxis after surgical evacuation were performed. Recurrence after MMA embolization requiring further treatment occurred in 7 cases (3.6%). All other patients had symptomatic relief with no further recurrence. No procedure-related complications were reported. Polyvinyl alcohol was the most commonly used material. Our series included 8 patients treated with Onyx. All had symptom relief and significant reduction in hematoma size; no recurrences or procedure-related complications were observed.
MMA embolization of CSDH is safe and effective for CSDH treatment based on a documented recurrence rate of 3.6% and lack of reported complications.
中脑膜动脉（MMA）栓塞已成为管理硬膜下血肿的一种微创手段。本研究的目的是系统地回顾文献，评估这种治疗方法的安全性和有效性，并分享我们的临床经验。
本研究已在 PROSPERO 上注册。使用 MeSH（医学主题词）术语在 PubMed、CINAHL、EMBASE 和 Cochrane Library 中搜索 2000 年 1 月至 2018 年 11 月 MMA 栓塞和慢性硬膜下血肿（CSDH）的文献。纳入所有描述 MMA 栓塞治疗 CSDH 的英文文献，无论研究设计如何。我们医院在 2017 年 1 月至 2018 年 6 月间连续接受 MMA 栓塞治疗的患者构成了我们的临床经验。
综述共纳入 15 项研究，共 193 例手术。95 例（49.2%）为原发性 MMA 栓塞；88 例（45.6%）为复发性 CSDH，10 例（5.2%）为手术清除后的预防性栓塞。7 例（3.6%）因 MMA 栓塞后复发需要进一步治疗。所有其他患者均有症状缓解，无进一步复发。未报告与手术相关的并发症。聚乙烯醇是最常用的材料。我们的系列研究中包括 8 例接受 Onyx 治疗的患者。所有患者均有症状缓解，血肿明显缩小；未观察到复发或与手术相关的并发症。
根据文献报道的复发率为 3.6%和无并发症报道，MMA 栓塞治疗 CSDH 是安全有效的。
