Alofi Abdulrahman D, Alsharif Thamer H, Alshamrani Abdulrahman A, Alsulami Adel A, Alamri Zeyad, Alsuwat Mashhour A
Neurosurgery, King Abdulaziz Specialist Hospital, Taif, Taif, SAU.
Neurosurgery, Royal College of Surgeons in Ireland, Dublin, IRL.
Cureus. 2024 Jun 7;16(6):e61874. doi: 10.7759/cureus.61874. eCollection 2024 Jun.
Chronic subdural hematoma (cSDH) is rare in the pediatric population and typically arises from various causes. These include trauma (accidental, non-accidental, or birth-related injuries), coagulopathies (such as hemophilia or von Willebrand disease), vascular malformations (such as arteriovenous malformations), and complications from previous surgeries. These diverse etiologies contribute to the complexity of managing this condition. Although middle meningeal artery (MMA) embolization is proven effective in adults, limited studies have investigated its applicability in pediatrics. This study aims to assess the efficacy, safety, and outcomes of MMA embolization in the pediatric age group, guiding future research and treatment strategies. A systematic review of the literature was conducted using PubMed, Web of Science, and Embase. No restrictions were applied regarding publication status or follow-up duration. The inclusion criteria were studies that integrated MMA embolization as a treatment for cSDH in pediatric patients. Data extracted included patient sample and characteristics, cSDH etiology and characteristics, prior intervention, procedural technique and indication, and clinical and radiological outcomes. Twelve studies were included in the review, comprising a total of 14 patients. There were no randomized clinical trials or large-scale cohort studies. The included literature consisted of 11 case reports and one case series, and the results described a clinical and radiological outcome in a varied mix of patients with different characteristics and backgrounds for cSDH. No neurological complications attributed to MMA embolization were reported. Follow-up showed resolved or decreased size of cSDH in all patients except for one, who experienced hematoma expansion despite treatment. MMA embolization may be considered a primary or adjuvant treatment modality for cSDH in the pediatric population. However, further research is needed to investigate the impact of different etiologies on outcomes and to highlight long-term complications and results.
慢性硬膜下血肿（cSDH）在儿科人群中较为罕见，通常由多种原因引起。这些原因包括创伤（意外、非意外或与出生相关的损伤）、凝血障碍（如血友病或血管性血友病）、血管畸形（如动静脉畸形）以及既往手术的并发症。这些不同的病因导致了该疾病管理的复杂性。尽管脑膜中动脉（MMA）栓塞在成人中已被证明有效，但针对其在儿科适用性的研究有限。本研究旨在评估MMA栓塞在儿科年龄组中的疗效、安全性和结果，为未来的研究和治疗策略提供指导。使用PubMed、科学网和Embase对文献进行了系统回顾。对发表状态或随访时间没有限制。纳入标准是将MMA栓塞作为儿科患者cSDH治疗方法的研究。提取的数据包括患者样本和特征、cSDH的病因和特征、先前的干预措施、手术技术和指征以及临床和影像学结果。该综述纳入了12项研究，共14例患者。没有随机临床试验或大规模队列研究。纳入的文献包括11篇病例报告和1篇病例系列，结果描述了不同特征和背景的cSDH患者的临床和影像学结果。未报告归因于MMA栓塞的神经并发症。随访显示，除1例患者在治疗后血肿扩大外，所有患者的cSDH均已消退或缩小。MMA栓塞可被视为儿科人群cSDH的主要或辅助治疗方式。然而，需要进一步研究以调查不同病因对结果的影响，并突出长期并发症和结果。
