Department of Neurosurgery, Aarhus University Hospital, Palle-Juul Jensens Boulevard 165, 8200, Aarhus, Denmark.
Department of Public Health, University of Southern Denmark, Winsløwsvej 9b, 5000, Odense C, Denmark.
Acta Neurochir (Wien). 2020 Apr;162(4):777-784. doi: 10.1007/s00701-020-04266-0. Epub 2020 Feb 21.
Chronic subdural hematoma (CSDH) remains a neurosurgical condition with high recurrence rate after surgical treatment. The primary pathological mechanism is considered to be repeated microbleedings from fragile neo-vessels within the outer hematoma membrane. The neo-vessels are supplied from peripheral branches of the middle meningeal artery, and embolization of MMA (eMMA) has been performed to prevent re-bleeding episodes and thereby CSDH recurrence.
To evaluate the published evidence for the effect of eMMA in patients with recurrent CSDH. Secondarily, to investigate the effect of eMMA as an alternative to surgery for primary treatment of CSDH.
A systematic review of the literature on eMMA in patients with recurrent CSDH was conducted. PubMed, Embase, and Cochrane databases were reviewed using the search terms: Embolization, Medial Meningeal Artery, Chronic Subdural Haematoma, and Recurrence. Furthermore, the following mesh terms were used: Chronic Subdural Haematoma AND embolization AND medial meningeal artery AND recurrence. Eighteen papers were found and included. No papers were excluded. The number of patients with primary CSDH and the number of patients with recurrent CSDH treated with eMMA were listed. Furthermore, the number of recurrences in both categories was registered.
Eighteen papers with a total of 191 included patients diagnosed with CSDH treated with eMMA for primary and recurrent CSDH were identified. Recurrence rate for patients treated with eMMA for recurrent CSDH was found to be 2.4%, 95% CI (0.5%; 11.0%), whereas the recurrence rate for patients treated with eMMA for primary CSDH was 4.1%, 95% CI (1.4%; 11.4%).
eMMA is a minimally invasive procedure for treatment of CSDH. Although this study is limited by publication bias, it seems that this procedure may reduce recurrence rates compared with burr hole craniostomy for both primary and recurrent hematomas. A controlled study is warranted.
慢性硬脑膜下血肿（CSDH）仍然是一种神经外科疾病，手术后复发率很高。主要的病理机制被认为是外血肿膜内脆弱的新生血管反复微出血。新生血管由脑膜中动脉的外周分支供应，因此已进行脑膜中动脉栓塞（eMMA）以防止再出血发作，从而防止 CSDH 复发。
评估 eMMA 在复发性 CSDH 患者中的疗效。其次，研究 eMMA 作为原发性 CSDH 治疗替代手术的效果。
对 eMMA 在复发性 CSDH 患者中的应用文献进行系统评价。通过检索术语“栓塞、脑膜中动脉、慢性硬脑膜下血肿、复发”，对 PubMed、Embase 和 Cochrane 数据库进行了检索。此外，还使用了以下主题词：慢性硬脑膜下血肿 AND 栓塞 AND 脑膜中动脉 AND 复发。共发现 18 篇论文并进行了纳入。未排除任何论文。列出了接受原发性 CSDH 治疗的患者人数和接受 eMMA 治疗的复发性 CSDH 患者人数。此外，还记录了这两个类别中的复发次数。
确定了 18 篇论文，共纳入 191 例接受 eMMA 治疗原发性和复发性 CSDH 的患者。接受 eMMA 治疗复发性 CSDH 的患者复发率为 2.4%，95%CI（0.5%；11.0%），而接受 eMMA 治疗原发性 CSDH 的患者复发率为 4.1%，95%CI（1.4%；11.4%）。
eMMA 是治疗 CSDH 的一种微创方法。尽管本研究受到发表偏倚的限制，但与颅骨钻孔术相比，该手术似乎可以降低原发性和复发性血肿的复发率。需要进行对照研究。
