Department of Neurosurgery, Lenox Hill Hospital, New York, NY, USA.
City University of New York School of Medicine, New York, NY, USA.
Curr Neurol Neurosci Rep. 2023 Apr;23(4):109-119. doi: 10.1007/s11910-023-01262-6. Epub 2023 Apr 11.
Chronic subdural hematoma (cSDH) is a common intracranial hemorrhagic disorder with a high incidence rate among the elderly. While small, asymptomatic cSDH may resolve spontaneously, surgical intervention has been the treatment of choice for larger, symptomatic cases. Surgical evacuation of cSDH may be associated with high rates of recurrence, and even asymptomatic cSDH cases tend to progress. Over the last few years, middle meningeal artery (MMA) embolization has proven to be a safe non-invasive treatment of choice with favorable outcomes and a low recurrence rate. The ensuing paper discusses current treatment modalities for cSDH and reviews existing literature on the anatomy of MMA and its embolization as a treatment option for cSDH.
Recent studies show that traumatic head injury leading to subdural hemorrhage can induce neovascularization that may initiate a cycle of recurrent subdural hematoma. Distal branches of MMA supply blood to the dural layers. Several studies have revealed that embolization of the MMA can stop the neovascularization process and blood flow. In addition, patients who underwent MMA embolization had a significantly quicker brain re-expansion and lower recurrence rate. Although the management of cSDH is still very much a dilemma, recent research findings bring MMA embolization to light as a promising treatment alternative and adjunctive therapy.
慢性硬脑膜下血肿（cSDH）是一种常见的颅内出血性疾病，在老年人中的发病率较高。小的无症状 cSDH 可能会自行消退，但对于较大的有症状病例，手术干预一直是首选治疗方法。cSDH 的手术清除可能与较高的复发率相关，甚至无症状的 cSDH 病例也往往会进展。在过去几年中，脑膜中动脉（MMA）栓塞已被证明是一种安全的非侵入性治疗选择，具有良好的疗效和较低的复发率。随后的论文讨论了 cSDH 的当前治疗方法，并回顾了 MMA 的解剖结构及其作为 cSDH 治疗选择的现有文献。
最近的研究表明，创伤性头部损伤导致的硬脑膜下出血可诱导新生血管形成，从而引发复发性硬脑膜下血肿的循环。MMA 的远端分支为硬脑膜层供血。几项研究表明，MMA 栓塞可以阻止新生血管形成过程和血流。此外，接受 MMA 栓塞治疗的患者脑复张更快，复发率更低。尽管 cSDH 的管理仍然存在很大的困境，但最近的研究结果表明，MMA 栓塞作为一种有前途的治疗选择和辅助治疗方法受到关注。
