Department of Neurosurgery, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, USA.
Medical College, Aga Khan University, Karachi 74800, Pakistan.
Clin Neurol Neurosurg. 2024 Nov;246:108580. doi: 10.1016/j.clineuro.2024.108580. Epub 2024 Oct 3.
To compare outcomes of middle meningeal artery embolization (MMAE) alone versus combined with conventional surgery in the management of chronic subdural hematoma (cSDH).
A systematic literature search was performed on PubMed, Google Scholar, Scopus, and CINAHL, followed by a meta-analysis comparing recurrence rates, surgical rescue, mortality, in-hospital complications, and length of hospital stay was conducted. Mean differences and risk ratios were pooled using a random effects model, with subgroup analysis performed using Cochrane RevMan 5.4.1 software.
A total of 23 studies including 302,168 patients (62.5 % male, 37.5 % female) were analyzed, with most studies published between 2017 and 2024. Among these patients, 299,195 (99.0 %) were treated with conventional surgery, whereas 3113 underwent MMAE. MMAE patients showed a significantly lower recurrence rate compared to conventional surgery, with a 0.35 times lower risk of recurrence (95 % CI: 0.24-0.51, p<0.01). However, adjunctive MMAE was associated with a longer hospital stay (SMD: 2.61 [95 % CI: 2.46-2.76], p<0.01), though MMAE alone had a shorter stay compared to adjunctive MMAE. Additionally, MMAE demonstrated a lower risk of surgical rescue (0.29 times, p<0.01). While no significant difference was found in-hospital complications (RR: 1.01, 95 % CI 0.90-1.14, p=0.84) and mortality rates (RR: 0.88, 95 % CI 0.69-1.14, p=0.34).
MMAE stand-alone or adjunctive with conventional surgery presents a promising alternative to conventional surgery alone for chronic subdural hematomas due to lower recurrence and surgical rescue risk. Further prospective studies are needed to study the efficacy of this new approach.
比较单独使用脑膜中动脉栓塞术（MMAE）与联合传统手术治疗慢性硬脑膜下血肿（cSDH）的结果。
对 PubMed、Google Scholar、Scopus 和 CINAHL 进行系统文献检索，随后进行荟萃分析，比较复发率、手术挽救、死亡率、住院期间并发症和住院时间。使用随机效应模型汇总均值差和风险比，并使用 Cochrane RevMan 5.4.1 软件进行亚组分析。
共分析了 23 项研究，包括 302168 名患者（62.5%为男性，37.5%为女性），其中大多数研究发表于 2017 年至 2024 年。在这些患者中，299195 名（99.0%）接受了传统手术治疗，而 3113 名接受了 MMAE 治疗。与传统手术相比，MMAE 患者的复发率显著降低，复发风险降低 0.35 倍（95%CI：0.24-0.51，p<0.01）。然而，辅助 MMAE 与住院时间延长相关（SMD：2.61 [95%CI：2.46-2.76]，p<0.01），尽管 MMAE 单独治疗的住院时间短于辅助 MMAE。此外，MMAE 显示出较低的手术挽救风险（0.29 倍，p<0.01）。尽管住院期间并发症（RR：1.01，95%CI 0.90-1.14，p=0.84）和死亡率（RR：0.88，95%CI 0.69-1.14，p=0.34）无显著差异。
MMAE 单独使用或联合传统手术治疗慢性硬脑膜下血肿，由于复发和手术挽救风险较低，是传统手术单独治疗的一种有前途的替代方法。需要进一步的前瞻性研究来研究这种新方法的疗效。
