Elfil Mohamed, Ghaith Hazem, Spirollari Eris, Sacknovitz Ariel, Jain Ankita, Rosenberg Jon, Bauerschmidt Andrew, Mayer Stephan A, Gandhi Chirag, Al-Mufti Fawaz
From the Department of Neurology, University of Miami/Jackson Health System, Miami, FL.
Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Cardiol Rev. 2025 Apr 23. doi: 10.1097/CRD.0000000000000922.
Chronic subdural hematoma (cSDH) is a prevalent neurosurgical condition with increasing incidence, especially among the elderly. The pathophysiology of cSDH is multifactorial, involving inflammation, fibrinolysis, and angiogenesis, with fragile neovascularization contributing to recurrent microbleeding and hematoma persistence. While burr-hole evacuation remains a standard surgical approach, recurrence rates remain high, necessitating adjunctive strategies such as subdural drain placement, subdural-peritoneal shunting, and pharmacologic interventions. Middle meningeal artery embolization (MMAE) has emerged as a promising adjunctive therapy for cSDH by targeting the abnormal neovascularization of the dura and within the hematoma's outer membrane. In this meta-analysis, we pooled data from 4 recent clinical trials (EMBOLISE, STEM, MAGIC-MT, and MEMBRANE) to evaluate MMAE's efficacy and safety. Our results demonstrate that MMAE plus usual care significantly reduces recurrence or residual cSDH compared with standard care alone (RR = 0.56, P = 0.001), and is associated with lower mortality (RR = 0.54, P = 0.03). No significant differences were observed in functional outcomes, serious adverse events, or major disabling stroke. These findings highlight MMAE as an effective adjunct in cSDH management. Future studies should aim to further assess long-term outcomes and cost-effectiveness, as well as refine the optimal patient selection criteria for MMAE.
慢性硬膜下血肿（cSDH）是一种常见的神经外科疾病，发病率呈上升趋势，在老年人中尤为明显。cSDH的病理生理学是多因素的，涉及炎症、纤维蛋白溶解和血管生成，脆弱的新生血管形成导致反复微出血和血肿持续存在。虽然钻孔引流仍然是标准的手术方法，但复发率仍然很高，因此需要采取辅助策略，如放置硬膜下引流管、硬膜下-腹腔分流术和药物干预。脑膜中动脉栓塞术（MMAE）已成为一种有前景的cSDH辅助治疗方法，其通过针对硬脑膜和血肿外膜内的异常新生血管形成发挥作用。在这项荟萃分析中，我们汇总了4项近期临床试验（EMBOLISE、STEM、MAGIC-MT和MEMBRANE）的数据，以评估MMAE的疗效和安全性。我们的结果表明，与单纯标准治疗相比，MMAE联合常规治疗可显著降低cSDH的复发或残留率（RR = 0.56，P = 0.001），且与较低的死亡率相关（RR = 0.54，P = 0.03）。在功能结局、严重不良事件或重大致残性卒中方面未观察到显著差异。这些发现突出了MMAE作为cSDH管理中一种有效辅助手段的作用。未来的研究应旨在进一步评估长期结局和成本效益，以及完善MMAE的最佳患者选择标准。
