Efficacy of middle meningeal artery embolization combined with surgery versus standalone surgery for chronic subdural hematoma: a comprehensive systematic review and Meta-Analysis with separate analysis of randomized controlled trials.

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY

Neuroradiology Pub Date : 2025-10-16 DOI:10.1007/s00234-025-03777-w

Ibrahim Mohammadzadeh, Bardia Hajikarimloo, Amirhossein Zare, Shahin Mohammadzadeh, Pooya Eini, Saba Aghajani, Ali Mortezaei, Mohammad Amin Habibi, Kivanc Yangi, Ahmet Günkan, Pascal Jabbour

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引用次数: 0

Abstract

Background: Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition with high recurrence rates after standard surgical evacuation. Middle meningeal artery embolization (MMAE) has emerged as a potential adjunct to reduce recurrence by targeting the vascular supply of neomembranes.

Objective: To evaluate the efficacy and safety of MMAE combined with surgery versus standalone surgical evacuation in patients with CSDH, through a comprehensive systematic review and meta-analysis, including separate analysis of randomized controlled trials (RCTs).

Methods: A systematic search of PubMed, Scopus, Web of Science, Embase, and Google Scholar was performed through March 2025. Dual-arm studies comparing MMAE plus surgery with surgery alone were included. Outcomes of interest were recurrence, complications, all-cause mortality, and functional outcome (modified Rankin Scale ≤ 2; mRS ≤ 2). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects model. Bias and evidence certainty were assessed via RoB tools and GRADE.

Results: Twenty-five studies (6 RCTs, 19 observational) comprising 119,812 patients were included. MMAE plus surgery significantly reduced recurrence (RR = 0.47, 95% CI: 0.36-0.62, p < 0.001; I² = 3.0%), without increasing complications (RR = 1.02, 95% CI: 0.8-1.3) or mortality (RR = 0.98, 95% CI: 0.72-1.33) compared with surgery alone. Functional outcomes were similar between both approaches (RR = 1.07, 95% CI: 0.93-1.23). Subanalysis of RCTs, was consistent with overall analysis showing a significant reduction in recurrence (RR = 0.44, 95% CI: 0.25-0.78) with MMAE plus surgery, without an increase in complications or mortality compared to surgery alone.

Conclusion: MMAE as an adjunct to surgery significantly lowers recurrence in CSDH. No significant differences in complications, mortality, or functional outcomes were detected compared with surgery alone; however, these outcomes are less common, and available studies may not have been adequately powered to exclude small but clinically meaningful effects.

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脑膜中动脉栓塞联合手术与单独手术治疗慢性硬膜下血肿的疗效：一项综合系统评价和随机对照试验的meta分析。

背景：慢性硬膜下血肿（CSDH）是一种常见的神经外科疾病，在标准手术后复发率很高。脑膜中动脉栓塞（MMAE）已成为一种潜在的辅助手段，通过靶向新膜的血管供应来减少复发。目的：通过全面的系统评价和meta分析，包括随机对照试验（RCTs）的单独分析，评价MMAE联合手术与单独手术引流治疗CSDH患者的疗效和安全性。方法：系统检索PubMed、Scopus、Web of Science、Embase、谷歌Scholar等数据库至2025年3月。包括比较MMAE加手术与单独手术的双臂研究。关注的结局是复发、并发症、全因死亡率和功能结局（改良Rankin量表≤2；mRS≤2）。采用随机效应模型估计95%置信区间（ci）的合并风险比（rr）。通过RoB工具和GRADE评估偏倚和证据确定性。结果：纳入25项研究（6项随机对照试验，19项观察性研究），共119,812例患者。MMAE联合手术可显著降低CSDH的复发（RR = 0.47, 95% CI: 0.36-0.62, p）。结论：MMAE联合手术可显著降低CSDH的复发。与单独手术相比，未发现并发症、死亡率或功能结局有显著差异；然而，这些结果并不常见，现有的研究可能没有足够的证据来排除小但有临床意义的影响。

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

Neuroradiology 医学-核医学

CiteScore

5.30

自引率

3.60%

发文量

214

审稿时长

4-8 weeks

期刊介绍： Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.