School of Medicine, SUNY Downstate Health Sciences University, New York, NY 11203, USA.
Department of Neurosurgery, Mount Sinai Health System, New York, NY 10029, USA.
Clin Neurol Neurosurg. 2024 Nov;246:108572. doi: 10.1016/j.clineuro.2024.108572. Epub 2024 Sep 23.
Conventional surgical modalities, including twist drill craniotomy, burr hole evacuation, and craniotomy, are the standard surgical interventions for chronic subdural hematomas (cSDH). More recently, treatment of cSDH with middle meningeal artery embolization (MMAE) is being explored. The comparative effectiveness of MMAE versus conventional surgical modalities remains controversial. The objective of this study is to analyze various postoperative outcomes in an umbrella review of existing meta-analysis comparing MMAE and conventional management in patients with cSDH.
A systematic literature search was executed with defined criteria across PubMed, Scopus, and Web of Science databases. Data was analyzed utilizing the metaumbrella R package, employing equivalent Hedges' g values. The quality assessment of each meta-analysis was carried out using AMSTAR2, assigning scores within the range of 0-11. The credibility of the evidence was determined by applying the Ioannidis criteria.
This umbrella review study included five meta-analyses. Upon pooling the meta-analyses, MMAE was associated with fewer reoperations and recurrence, supported by a weak level of evidence (class IV). Conversely, findings related to other postoperative outcomes did not reach statistical significance.
Our umbrella review offers a comprehensive summary investigating MMAE and conventional management for the treatment of cSDH. MMAE had fewer reoperations and recurrence, but they were classified as being of weak significance. These findings underscore insufficient evidence within the existing literature, emphasizing the imperative need for additional research in this area.
传统的手术方式，包括旋转钻头开颅术、颅骨钻孔引流术和开颅术，是慢性硬脑膜下血肿（cSDH）的标准手术干预措施。最近，中脑膜动脉栓塞术（MMAE）治疗 cSDH 也在探索中。MMAE 与传统手术方式的比较效果仍存在争议。本研究的目的是在现有的比较 MMAE 和传统管理治疗 cSDH 的荟萃分析的伞式综述中分析各种术后结果。
使用定义的标准在 PubMed、Scopus 和 Web of Science 数据库中进行系统文献检索。使用 metaumbrella R 包分析数据，利用等效的 Hedges'g 值。使用 AMSTAR2 对每项荟萃分析的质量进行评估，评分为 0-11 分。通过应用 Ioannidis 标准来确定证据的可信度。
这项伞式综述研究包括五项荟萃分析。荟萃分析结果表明，MMAE 与较少的再次手术和复发相关，证据水平较弱（IV 级）。然而，与其他术后结果相关的发现没有达到统计学意义。
我们的伞式综述提供了一项综合研究，调查了 MMAE 和传统管理治疗 cSDH 的效果。MMAE 再次手术和复发的风险较低，但被归类为意义较弱。这些发现强调了现有文献中证据不足，强调了在该领域进一步研究的必要性。
