Embolization of the middle meningeal artery as a nonsurgical option for chronic subdural hematoma: a prospective matching study.

IF 3 2区医学 Q2 CLINICAL NEUROLOGY

Neurosurgical focus Pub Date : 2025-10-01 DOI:10.3171/2025.7.FOCUS25275

Arwed E Michael, Jana Rediker, Ulrich Knappe, Matthias M Woeltjen, Denise Schoenbeck, Jan Borggrefe, Christoph Moenninghoff

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Abstract

Objective: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases. Middle meningeal artery embolization (MMAE) is a treatment option in addition or as an alternative to conservative or surgical therapy. The objective of this study was to investigate whether MMAE can be used as a primary treatment method in patients with CSDH without an acute indication for surgery, and as a therapeutic option instead of a reoperation in cases of recurrence after surgery.

Methods: Fifty-one patients with MMAE as the primary treatment method for CSDH or for cases of recurrence after surgical treatment were prospectively included. A retrospective matching with patients treated only surgically was performed using the criteria of age, gender, size and side of the CSDH, as well as anticoagulation therapy. In the follow-up, the frequency of rescue operations and complications and the resumption of anticoagulation treatment were analyzed.

Results: Eleven patients with MMAE and 14 controls underwent rescue surgery due to relevant worsening of symptoms (p = 0.638). None of the patients with MMAE experienced a complication, compared with 7 of the controls (p = 0.012). When anticoagulation treatment was resumed, there was a tendency in favor of MMAE (p = 0.058).

Conclusions: There is a tendency toward superiority of MMAE for CSDH in certain patients. However, uncertainties remain regarding the exact methodology and optimal indications, and further research will be needed.

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脑膜中动脉栓塞作为治疗慢性硬膜下血肿的非手术选择：一项前瞻性匹配研究。

目的：慢性硬膜下血肿是神经外科最常见的疾病之一。脑膜中动脉栓塞（MMAE）是除保守或手术治疗外的一种治疗选择。本研究的目的是探讨MMAE是否可以作为无急性手术指征的CSDH患者的主要治疗方法，以及在术后复发的情况下作为治疗选择而不是再次手术。方法：前瞻性纳入51例以MMAE为主要治疗方法的CSDH或手术后复发病例。采用年龄、性别、大小、CSDH一侧以及抗凝治疗的标准，对仅手术治疗的患者进行回顾性匹配。随访中分析抢救手术次数、并发症及抗凝治疗恢复情况。结果：11例MMAE患者和14例对照组因相关症状加重而行抢救手术（p = 0.638）。与对照组的7例相比，MMAE患者没有发生并发症（p = 0.012）。当恢复抗凝治疗时，倾向于MMAE （p = 0.058）。结论：MMAE在某些CSDH患者中有优势的趋势。然而，关于确切的方法和最佳适应症仍然存在不确定性，需要进一步研究。

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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