Chen Huanwen, Colasurdo Marco, Kan Peter T
1National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.
2Department of Neurology, MedStar Georgetown University Hospital, Washington, DC.
J Neurosurg. 2023 Sep 29;140(3):819-825. doi: 10.3171/2023.7.JNS231262. Print 2024 Mar 1.
Middle meningeal artery embolization (MMAE) is a novel treatment for chronic subdural hematomas (cSDHs) with high variability of use across practitioners and institutions. This study sought to investigate whether standalone MMAE may be an effective alternative to combined MMAE and surgery for select patients with cSDH.
The authors searched the Medline and Embase databases for studies reporting outcomes specific to standalone MMAE and combined MMAE and surgery. The Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool was used to assess risk of bias in each included study. Patient characteristics were compared between cohorts, and rates of surgical recurrence of standalone MMAE and combined MMAE and surgery were pooled using random-effects models.
Four hundred two unique patients (156 with standalone MMAE and 246 with combined MMAE and surgery) were identified across 8 studies. Overall, the subdural thickness for the standalone MMAE group was modestly but statistically significantly smaller (16.8 vs 18.8 mm, estimated p value 0.002), and the mean follow-up time was significantly longer for the standalone MMAE group (5.4 vs 2.3 months, estimated p value < 0.001); there were no significant differences between age, sex, and anticoagulant use. The surgical recurrence rates were not significantly different between the two groups (estimated p value 0.63). Using random-effects models, the surgical recurrence rates were estimated at 6.8% (95% CI 3.5%-11.2%) and 4.6% (95% CI 2.3%-7.7%) for standalone MMAE and combined MMAE and surgery, respectively.
Standalone MMAE for cSDH may yield a low rate of surgical recurrence, which may be comparable to that of combined MMAE and surgery. However, studies in this systematic review and meta-analysis were primarily single-arm studies prone to treatment bias. Future studies are needed to further investigate whether standalone MMAE may be an effective alternative to combined MMAE and surgical treatment for cSDH in select patients.
脑膜中动脉栓塞术（MMAE）是一种治疗慢性硬膜下血肿（cSDH）的新型方法，不同医生和机构对其使用差异很大。本研究旨在调查对于部分cSDH患者，单纯MMAE是否可能是MMAE联合手术的有效替代方法。
作者检索了Medline和Embase数据库，查找报告单纯MMAE以及MMAE联合手术的具体结果的研究。使用干预性非随机研究的偏倚风险（ROBINS-I）工具评估每项纳入研究的偏倚风险。比较各队列之间的患者特征，并使用随机效应模型汇总单纯MMAE和MMAE联合手术的手术复发率。
在8项研究中确定了402例独特患者（156例接受单纯MMAE，246例接受MMAE联合手术）。总体而言，单纯MMAE组的硬膜下厚度略小但具有统计学意义（16.8对18.8毫米，估计p值0.002），单纯MMAE组的平均随访时间明显更长（5.4对2.3个月，估计p值<0.001）；年龄、性别和抗凝剂使用方面无显著差异。两组的手术复发率无显著差异（估计p值0.63）。使用随机效应模型，单纯MMAE和MMAE联合手术的手术复发率估计分别为6.8%（95%CI 3.5%-11.2%）和4.6%（95%CI 2.3%-7.7%）。
cSDH的单纯MMAE可能产生较低的手术复发率，这可能与MMAE联合手术相当。然而，本系统评价和荟萃分析中的研究主要是单臂研究，容易出现治疗偏倚。未来需要进一步研究对于部分cSDH患者，单纯MMAE是否可能是MMAE联合手术治疗的有效替代方法。
