Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore.
Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore.
Neurosurg Rev. 2024 Nov 28;47(1):876. doi: 10.1007/s10143-024-03107-3.
The procedure of middle meningeal artery embolization (MMAE) has emerged as a minimally invasive therapy for chronic subdural hematoma (CSDH). Previous studies comparing MMAE with conventional treatment for CSDH did not differentiate primary/upfront, adjunct, or rescue MMAE, and included both conservative and surgical treatment in the comparison group. We conducted a systematic review and meta-analysis to compare outcomes after adjunct MMAE (MMAE combined with surgical evacuation) versus surgery alone for CSDH.
PubMed, Embase, Cochrane, Web of Science, and Scopus databases were searched to August 2023. Primary outcomes were treatment failure and reoperation. Secondary outcomes were complications, mortality, length of hospital stay, 30-day readmission, and follow-up modified Rankin Scale (mRS) > 2. Additional data from our institution was included.
12 published studies and our data yielded 57,165 patients, of whom 1,065 (1.9%) received adjunct MMAE and 56,100 (98.1%) surgery alone. Compared to surgery alone, adjunct MMAE was associated with lower rates of treatment failure (OR = 0.43 [0.23-0.83], p = 0.01), reoperation (OR = 0.45 [0.22-0.90], p = 0.02), and 30-day readmission (OR = 0.50 [0.34-0.73], p < 0.001). Length of hospital stay (MD = 2.49 [-0.51, 5.49], p = 0.10) was non-significantly longer in the adjunct MMAE group. Both groups had comparable rates of treatment-related complications (OR = 0.89 [0.52-1.53], p = 0.67), mortality (OR = 1.05 [0.75-1.46], p = 0.78), and follow-up mRS > 2 (OR = 0.91 [0.39-2.12], p = 0.83).
Adjunct MMAE reduces treatment failure, reoperation, and readmission rates without increasing morbidity and mortality. MMAE may be considered as an adjunct to surgical evacuation to reduce CSDH recurrence. Randomized trials will further establish the evidence for adjunct MMAE and its role in the management of CSDH.
脑膜中动脉栓塞术（MMAE）已成为慢性硬脑膜下血肿（CSDH）的一种微创治疗方法。先前比较 MMAE 与 CSDH 常规治疗的研究没有区分原发性/初始、辅助或挽救性 MMAE，并且在对照组中同时包括了保守治疗和手术治疗。我们进行了一项系统评价和荟萃分析，以比较辅助 MMAE（MMAE 联合手术清除）与单独手术治疗 CSDH 的结果。
检索了 PubMed、Embase、Cochrane、Web of Science 和 Scopus 数据库，检索时间截至 2023 年 8 月。主要结局是治疗失败和再次手术。次要结局是并发症、死亡率、住院时间、30 天再入院和随访改良 Rankin 量表（mRS）>2。还纳入了我们机构的额外数据。
12 项已发表的研究和我们的数据共纳入了 57165 名患者，其中 1065 名（1.9%）接受了辅助 MMAE，56100 名（98.1%）接受了单独手术治疗。与单独手术相比，辅助 MMAE 治疗失败的发生率较低（OR=0.43 [0.23-0.83]，p=0.01）、再次手术的发生率较低（OR=0.45 [0.22-0.90]，p=0.02）和 30 天再入院率较低（OR=0.50 [0.34-0.73]，p<0.001）。辅助 MMAE 组的住院时间（MD=2.49 [-0.51, 5.49]，p=0.10）非显著延长。两组的治疗相关并发症发生率（OR=0.89 [0.52-1.53]，p=0.67）、死亡率（OR=1.05 [0.75-1.46]，p=0.78）和随访 mRS>2（OR=0.91 [0.39-2.12]，p=0.83）相似。
辅助 MMAE 可降低治疗失败、再次手术和再入院率，而不会增加发病率和死亡率。MMAE 可考虑作为手术清除的辅助手段，以降低 CSDH 的复发率。随机试验将进一步确定辅助 MMAE 的证据及其在 CSDH 管理中的作用。
