Chronic Subdural Hematoma: A Review of Current Knowledge, Treatment Modalities, and Clinical Trials of Middle Meningeal Artery Embolization.

IF 3.2 Q3 CLINICAL NEUROLOGY
Neurology. Clinical practice Pub Date : 2025-08-01 Epub Date: 2025-07-07 DOI:10.1212/CPJ.0000000000200501
Huanwen Chen, Marco Colasurdo, Uttam K Bodanapally, Ajay Malhotra, Dheeraj Gandhi
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Abstract

Purpose of review: While chronic subdural hematoma (cSDH) has been considered a neurosurgical disease, conventional management with surgical evacuation has been associated with high rates of disease recurrence and long-term patient morbidity and mortality. In this narrative review, we summarize the current knowledge regarding the epidemiology, pathophysiology, and treatment modalities for cSDH with a particular focus on middle meningeal artery embolization (MMAE) and other novel treatment modalities.

Recent findings: A growing body of literature has suggested that inflammation and angiogenesis may play a central role in cSDH pathophysiology, and major advances have been made on nonsurgical treatment modalities for cSDH such as MMAE and antiangiogenic agents. Furthermore, recent studies, including several large randomized controlled trials, have confirmed that MMAE is generally an effective treatment for promoting cSDH resorption and reducing recurrence rates.

Summary: Chronic SDH is a common neurovascular disease that is expected to increase in incidence because of global population aging and widespread use of antithrombotic medications. The current pathophysiologic understanding suggests that cSDHs may form because of a positive feedback loop of inflammation, angiogenesis, and persistent exudation of blood into the subdural space. Surgical management is the standard treatment for relieving acute neurologic deficits; however, rates of cSDH recurrence are high and risks of perioperative morbidity and mortality are substantial. Conservative medical management options for cSDH are limited. MMAE is a novel treatment with high-quality data from multiple randomized trials suggesting efficacy regarding preventing cSDH recurrence and promoting hematoma resorption.

慢性硬膜下血肿:当前知识、治疗方式和脑膜中动脉栓塞的临床试验综述。
回顾目的:慢性硬膜下血肿(cSDH)一直被认为是一种神经外科疾病,传统的手术引流治疗与高疾病复发率和长期患者发病率和死亡率相关。在这篇叙述性综述中,我们总结了目前关于cSDH的流行病学、病理生理学和治疗方式的知识,特别关注脑膜中动脉栓塞(MMAE)和其他新的治疗方式。最近发现:越来越多的文献表明炎症和血管生成可能在cSDH的病理生理中起核心作用,并且在cSDH的非手术治疗方式如MMAE和抗血管生成药物方面取得了重大进展。此外,最近的研究,包括几项大型随机对照试验,已经证实MMAE通常是促进cSDH吸收和降低复发率的有效治疗方法。摘要:慢性SDH是一种常见的神经血管疾病,由于全球人口老龄化和抗血栓药物的广泛使用,预计其发病率将增加。目前病理生理学的理解表明,cSDHs可能是由于炎症、血管生成和持续的血液渗出到硬膜下空间的正反馈循环而形成的。外科治疗是缓解急性神经功能缺损的标准治疗方法;然而,cSDH的复发率很高,围手术期发病率和死亡率的风险很大。cSDH的保守医疗管理选择有限。MMAE是一种新的治疗方法,来自多个随机试验的高质量数据表明,MMAE具有预防cSDH复发和促进血肿吸收的功效。
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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来源期刊
Neurology. Clinical practice
Neurology. Clinical practice CLINICAL NEUROLOGY-
CiteScore
4.00
自引率
0.00%
发文量
77
期刊介绍: Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.
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