Department of Neurosurgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.
Department of Neurosurgery, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
Neurosurg Rev. 2023 Sep 11;46(1):239. doi: 10.1007/s10143-023-02130-0.
Chronic subdural hematoma (CSDH) is a disease commonly found in the elderly and not a typical finding in pediatric population. History of shunt surgery, child abuse, and blood disorder are some of the common causes of pediatric CSDH (pCSDH). There is growing evidence about the role of middle meningeal artery embolization (MMAE) to manage CSDH in the elderly population with a high risk of rebleeding. However, the evidence in the pediatric population is still sparse. A systematic literature search was conducted on PubMed, Scopus, and Web of Science database from January, 2023, to March, 2023. Search strings were generated based on the combination of modified search terms, such as CSDH, MMA embolization, and child. Risk of bias was assessed using the Cochrane Risk of Bias in Nonrandomized Study for Intervention. Nine articles were included in this review. The success rate of MMA embolization in pediatric CSDH was 88.8%. Histories of ventriculoperitoneal shunt, blood coagulation disorder, and trauma were the causes of CSDH. Time to achieve success was varied from 2 to 9 months. No study with low risk of bias was found. This systematic review found no high-quality evidence regarding the role of MMA embolization in the management of pCSDH. However, due to its high success rate, MMAE could be a promising approach to treat pCSDH.
慢性硬脑膜下血肿（CSDH）是一种常见于老年人的疾病，而不是儿科人群中的典型疾病。分流术史、儿童虐待和血液疾病是小儿 CSDH（pCSDH）的一些常见病因。越来越多的证据表明，中脑膜动脉栓塞（MMAE）在有再出血高风险的老年人群中治疗 CSDH 具有重要作用。然而，儿科人群中的证据仍然很少。本系统评价于 2023 年 1 月至 3 月，在 PubMed、Scopus 和 Web of Science 数据库中进行了系统文献检索。搜索词基于改良搜索词的组合生成，如 CSDH、MMA 栓塞和儿童。使用非随机干预研究的 Cochrane 偏倚风险评估来评估偏倚风险。本综述共纳入 9 篇文章。小儿 CSDH 行 MMA 栓塞的成功率为 88.8%。脑室-腹腔分流术史、凝血功能障碍和外伤是 CSDH 的病因。达到成功的时间从 2 至 9 个月不等。未发现低偏倚风险的研究。本系统评价未发现关于 MMAE 在治疗 pCSDH 中的作用的高质量证据。然而，由于其成功率较高，MMAE 可能是治疗 pCSDH 的一种很有前途的方法。
