Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 E 68thSt., M-220, Box 99, New York, NY, 10065, USA.
Curr Pain Headache Rep. 2022 Aug;26(8):657-665. doi: 10.1007/s11916-022-01068-0. Epub 2022 Jul 8.
The purpose of this review is to present a brief background on chronic subdural hematomas (cSDH), middle meningeal artery (MMA) embolization, and its role in decreasing recurrence of cSDH. A review of the most up-to-date literature should demonstrate the efficacy of this procedure.
The latest data shows that MMA embolization is a safe procedure, with low complication rates and low recurrence rates. While cSDH managed with surgical evacuation can have a recurrence rate upwards of 30%, MMA embolization alone or as an adjunct to surgery decreases recurrence to less than 5% in most studies. MMA embolization can be especially useful in high-risk populations such as the elderly, patients on anti-platelet medication, and those with coagulopathies. It can also be done awake, done without general anesthesia, and is significantly less invasive than traditional surgical techniques. In reviewing the literature on MMA embolization, it is clear that there are numerous retrospective studies and systematic reviews demonstrating its safety and efficacy, and some prospective dual-arm studies that present novel information. The numerous clinical trials that are currently underway should help to further establish MMA embolization as standard of care in the management of cSDH.
本文旨在简要介绍慢性硬脑膜下血肿（cSDH）、脑膜中动脉（MMA）栓塞及其在降低 cSDH 复发率中的作用。对最新文献的回顾应该能够证明该手术的疗效。
最新数据表明，MMA 栓塞是一种安全的手术，并发症发生率和复发率都较低。虽然通过手术清除硬脑膜下血肿的复发率高达 30%，但在大多数研究中，MMA 栓塞单独或作为手术的辅助手段可将复发率降低至 5%以下。MMA 栓塞在高危人群中特别有用，如老年人、服用抗血小板药物的患者和凝血功能障碍的患者。它还可以在清醒状态下进行，无需全身麻醉，并且比传统手术技术创伤性小得多。通过对 MMA 栓塞文献的回顾，可以清楚地看到有许多回顾性研究和系统评价证明了其安全性和有效性，还有一些前瞻性双臂研究提出了新的信息。目前正在进行的许多临床试验应该有助于进一步确立 MMA 栓塞作为 cSDH 治疗标准的地位。
