Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, California.
Student Research Committee, Shiraz University of Medical Sciences, Shiraz; Research Center for Neuromodulation and Pain, Shiraz.
J Vasc Interv Radiol. 2023 Sep;34(9):1493-1500.e7. doi: 10.1016/j.jvir.2023.05.010. Epub 2023 May 12.
To assess the efficacy and safety of middle meningeal artery (MMA) embolization with liquid embolic agents and the outcomes of patients following this procedure.
A review of the literature was conducted to identify studies investigating the efficacy and safety of MMA embolization with liquid embolic agents in patients with chronic subdural hematoma (cSDH) in PubMed, Scopus, Embase, and Web of Science. The keywords "liquid embolic agent," "middle meningeal artery," "cSDH," and "embolization" as well as their synonyms were used to build up the search strategy. The R statistical software and random-effects model were used for analysis. Heterogeneity was reported as I, and publication bias was calculated using the Egger test.
Of 628 articles retrieved, 14 studies were eligible to be included in this study. Data of 276 patients were analyzed. n-Butyl cyanoacrylate and ethylene vinyl alcohol copolymer were the most commonly used embolic agents. This study revealed a pooled mortality rate of 0% (95% confidence interval [CI], 0.00%-100%), recurrence and failure rate of 3% (95% CI, 1%-10%), reoperation/reintervention rate of 4% (95% CI, 2%-12%), rate of size decrease of 94% (95% CI, 79%-98%), technical success rate of 100% (95% CI, 76%-100%), and adverse event rate of 1% (95% CI, 0.00%-4%).
With low mortality, recurrence, reoperation, and adverse event rates and a remarkable decrease in the size of hematomas, MMA embolization with liquid embolic agents may be considered a safe and effective treatment option in patients in whom surgical intervention has previously failed and as an alternative to conventional treatments.
评估使用液态栓塞剂对中间脑膜动脉（MMA）进行栓塞的疗效和安全性，以及该治疗方法后患者的结局。
在 PubMed、Scopus、Embase 和 Web of Science 中检索文献，以评估使用液态栓塞剂对慢性硬脑膜下血肿（cSDH）患者 MMA 栓塞的疗效和安全性。关键词为“液体栓塞剂”“中间脑膜动脉”“cSDH”和“栓塞”及其同义词，以建立搜索策略。使用 R 统计软件和随机效应模型进行分析。采用 I 报告异质性，并使用 Egger 检验计算发表偏倚。
在检索到的 628 篇文章中，有 14 项研究符合纳入标准。共分析了 276 例患者的数据。n-丁基氰丙烯酸酯和乙烯-乙烯醇共聚物是最常用的栓塞剂。本研究显示，总体死亡率为 0%（95%置信区间 [CI]，0.00%-100%），复发和失败率为 3%（95% CI，1%-10%），再次手术/再次干预率为 4%（95% CI，2%-12%），血肿缩小率为 94%（95% CI，79%-98%），技术成功率为 100%（95% CI，76%-100%），不良事件发生率为 1%（95% CI，0.00%-4%）。
对于先前手术治疗失败的患者，以及作为传统治疗方法的替代方法，使用液态栓塞剂对 MMA 进行栓塞治疗具有较低的死亡率、复发率、再次手术率和不良事件率，并且血肿显著缩小，可被认为是一种安全有效的治疗选择。
