Endovascular Embolization for Chronic Subdural Hematomas: A Literature Review of the Current Evidence.

IF 1 Q3 MEDICINE, GENERAL & INTERNAL
Cureus Pub Date : 2025-03-20 eCollection Date: 2025-03-01 DOI:10.7759/cureus.80898
Andrés Sebastián Estrella López, Naomi Pauleth Espin Jiménez, Patricio Alejandro Montalvo Ramos, Gabriela Alejandra Castillo López
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Abstract

Chronic subdural hematoma (cSDH) primarily affects elderly patients along with those who have multiple health problems, while it develops when blood collects between the dura mater and the brain. The condition results in substantial disability while also causing surgical treatment failures in certain cases. The occurrence of cSDH becomes more frequent as people age beyond 65 years old, which establishes this condition as a major health issue. The standard surgical evacuation method for treating this condition shows limited success because patients experience frequent recurrences, which motivates researchers to study endovascular embolization as an alternative treatment option. The promising endovascular embolization technique uses middle meningeal artery (MMA) embolization to target the blood supply of the neo-membrane surrounding the hematoma, thus preventing rebleeding and reducing recurrence. The available data shows that embolization of the MMA leads to better recurrence prevention than conventional surgical procedures among patients who face restrictions for surgery because of multiple health issues. The review analyzes current research about MMA embolization safety together with its effectiveness and appropriate applications for cSDH treatment. The existing evidence about endovascular embolization as adjunctive therapy to surgical procedures such as burr hole drainage or craniotomy provides a significant impact over standalone treatment for complex and recurrent cSDH cases, reducing recurrence, rescue rates, and complications. However, endovascular embolization also shows better clinical outcomes in reducing these outcomes, but for less complex cSDH cases. There is unclear or inconclusive evidence for overall cSDH patients because current research lacks large multicenter randomized controlled studies together with stringent quality standards and contains various patient groups and minimal study durations. The procedure's effectiveness remains unclear because researchers have not determined the best patient selection criteria, the most suitable embolic agent, or the most economical approach.

慢性硬膜下血肿(cSDH)主要影响老年患者和有多种健康问题的患者,当血液聚集在硬脑膜和大脑之间时就会发病。这种情况会导致严重残疾,在某些情况下还会导致手术治疗失败。随着 65 岁以上人群年龄的增长,cSDH 的发病率会越来越高,这也使得这种疾病成为一个重大的健康问题。由于患者经常复发,治疗这种病症的标准手术抽空方法效果有限,这促使研究人员开始研究血管内栓塞作为替代治疗方案。前景广阔的血管内栓塞技术采用脑膜中动脉(MMA)栓塞,以血肿周围新膜的血液供应为目标,从而防止再出血并减少复发。现有数据显示,在因多种健康问题而面临手术限制的患者中,脑膜中动脉栓塞术比传统手术方法能更好地预防复发。本综述分析了目前有关 MMA 栓塞安全性的研究及其有效性和在 cSDH 治疗中的适当应用。现有证据表明,血管内栓塞作为毛细孔引流术或开颅手术等外科手术的辅助疗法,对复杂和复发性 cSDH 病例的治疗效果明显优于单独治疗,可降低复发率、抢救率和并发症。不过,血管内栓塞治疗在减少这些结果方面也显示出更好的临床效果,但适用于不太复杂的 cSDH 病例。由于目前的研究缺乏大型多中心随机对照研究和严格的质量标准,且包含不同的患者群体和最短的研究时间,因此针对所有 cSDH 患者的证据尚不明确或没有定论。由于研究人员尚未确定最佳的患者选择标准、最合适的栓塞剂或最经济的方法,因此该手术的有效性仍不明确。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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