Gajjar Avi A, Naqvi Ali, Chen John Y, Custozzo Amanda, Boulos Alan S, Dalfino John C, Field Nicholas C, Paul Alexandra R
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
Interv Neuroradiol. 2025 Apr 4:15910199251329970. doi: 10.1177/15910199251329970.
Background and objectivesMiddle meningeal artery embolization (MMAE) has become a pivotal intervention in managing chronic subdural hematomas (cSDHs). This systematic review synthesizes past, recent, and ongoing clinical trials to assess MMAE's role in cSDH treatment.MethodsA systematic review was conducted using PRISMA guidelines, incorporating PubMed, ClinicalTrials.gov, and reverse bibliography searches to identify clinical trials evaluating MMAE for cSDH. Inclusion criteria included randomized and nonrandomized trials reporting outcomes, such as recurrence rates and procedural safety. Case reports, retrospective reviews, and opinion pieces were excluded.ResultsSeven published and 15 ongoing trials were identified. Landmark randomized controlled trials (RCTs), including EMBOLISE, STEM, and MAGIC-MT, demonstrated reductions in hematoma recurrence and surgical rescues with MMAE, establishing its role as both an adjunctive and standalone therapy. Ongoing trials, such as EMPROTECT and CHESS, investigate diverse embolic agents, procedural strategies, and patient populations to optimize MMAE outcomes. However, challenges remain, including variability in patient selection criteria, embolic materials, and endpoints.ConclusionMMAE is an innovative and minimally invasive approach that has reshaped cSDH management. Evidence supports its efficacy and safety as an adjunct to surgery and a potential standalone therapy for select patients. Future research should focus on long-term outcomes, subgroup analyses, and standardization of protocols to further refine its application and integration into clinical practice.
背景与目的
脑膜中动脉栓塞术（MMAE）已成为治疗慢性硬膜下血肿（cSDH）的关键干预手段。本系统评价综合了过去、近期及正在进行的临床试验，以评估MMAE在cSDH治疗中的作用。
方法
采用PRISMA指南进行系统评价，纳入PubMed、ClinicalTrials.gov检索，并通过反向参考文献检索，以识别评估MMAE治疗cSDH的临床试验。纳入标准包括报告复发率和手术安全性等结局的随机和非随机试验。排除病例报告、回顾性综述和观点文章。
结果
共识别出7项已发表试验和15项正在进行的试验。具有里程碑意义的随机对照试验（RCT），包括EMBOLISE、STEM和MAGIC-MT，显示MMAE可降低血肿复发率并减少手术补救措施，确立了其作为辅助治疗和独立治疗的作用。正在进行的试验，如EMPROTECT和CHESS，正在研究不同的栓塞剂、手术策略和患者群体，以优化MMAE的治疗效果。然而，挑战依然存在，包括患者选择标准、栓塞材料和终点的变异性。
结论
MMAE是一种创新的微创方法，重塑了cSDH的治疗模式。有证据支持其作为手术辅助手段以及对特定患者潜在的独立治疗方法的有效性和安全性。未来的研究应聚焦于长期结局、亚组分析和方案标准化，以进一步优化其应用并将其融入临床实践。
