不同技术在慢性硬膜下血肿治疗中的比较——脑膜中动脉栓塞的作用是什么？：系统综述和网络荟萃分析

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-06-04 DOI:10.1016/j.clineuro.2025.108995

Luis F. Fabrini Paleare , Sávio Batista , Raphael Camerotte , Ocílio Ribeiro Gonçalves , Lucas Pari Mitre , Pedro Guimarães Lameira Bittencourt Borges , Marina Vilardo , Henrique Maia , Christian Ken Fukunaga , Jhon E. Bocanegra-Becerra , Bernardo Vieira Nogueira , André Luis Dias de Figueiredo , Ricardo Nascimento Brito , Márcio Yuri Ferreira , Gustavo Sousa Noleto , Wellingson Silva Paiva

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引用次数: 0

摘要

背景：慢性硬膜下血肿（cSDHs）是一种潜在的危及生命的神经系统疾病，在世界范围内的发病率越来越高。然而，关于不同的cSDH管理的比较数据仍然有限。在此，我们旨在进行一项网络荟萃分析，比较独立栓塞（EMB）、手术、EMB +手术（EMBSurgery）和观察，以提供进一步的清晰度。方法系统检索PubMed、Embase、Web of Science和Cochrane Library，检索比较EMB、手术、EMBSurgery和观察至少两种cSDH方法的研究。主要终点包括再次干预的需要、住院时间、手术相关并发症和死亡率。采用随机效应模型计算95 %置信区间（CI）下的均值差（MD）和比值比（OR）。对随机研究进行成本效益分析和亚组分析。结果共纳入19项研究，患者23996例。与手术相比，EMB手术的再干预率显著降低（OR 0.21, CI 0.04-0.79），而EMB的再干预率无显著降低（OR 0.41, CI 0.12-1.32）。与手术相比，emb手术既没有显著增加住院时间（MD 4.80, CI - 0.435-11.4），也没有产生更高的并发症（OR 1.11, CI 0.49-2.36）。事实上，两组患者的死亡率都较低(EMB: OR 0.61, CI 0.03-5.08；EMB手术：OR 0.41, CI 0.03-3.05)，与手术相比，EMB和EMB手术的手术成本并没有显著增加(EMB: MD 32,000, CI -13,500-70,300；emb外科：MD 16,200, CI -40,100-72,600)。亚分析显示，EMBSurgery组的再干预率明显低于手术组(OR 0.34, CI 0.16-0.74；I2 0 %)。结论与单独手术相比，emb联合手术似乎减少了cSDH的再干预，无明显并发症，需要通过更长随访时间的随机试验进一步分析。

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Comparing different techniques in the management of chronic subdural hematoma - What is the role of middle meningeal artery embolization?: A systematic review and network meta-analysis

Background

Chronic subdural hematomas (cSDHs) are potentially life-threatening neurological conditions with an increasing incidence worldwide. However, comparative data on the different cSDH managements remain limited. Herein, we aimed to conduct a network meta-analysis comparing standalone embolization (EMB), surgery, EMB plus surgery (EMBSurgery), and observation, to provide further clarity.

Method

We systematically searched PubMed, Embase, Web of Science, and Cochrane Library for studies comparing at least two cSDH approaches between EMB, surgery, EMBSurgery, and observation. Primary endpoints included the need for reintervention, length of hospital stay, procedure-related complications, and mortality. Random-effects model was used to calculate mean difference (MD) and odds ratio (OR) under a 95 % confidence interval (CI). Cost-effective analysis and subanalyses for the randomized studies were conducted.

Results

A total of 19 studies involving 23,996 patients were included. A significant reduction in reintervention was observed with EMBSurgery (OR 0.21, CI 0.04–0.79), while EMB showed a non-significant reduction (OR 0.41, CI 0.12–1.32), compared to surgery. EMBSurgery neither significantly increased hospital stay (MD 4.80, CI −0.435–11.4) nor yielded higher complications (OR 1.11, CI 0.49–2.36) compared to surgery. Indeed, lower mortality was observed in both groups (EMB: OR 0.61, CI 0.03–5.08; EMBSurgery: OR 0.41, CI 0.03–3.05) and procedural costs were not significantly higher for EMB and EMBSurgery compared to surgery (EMB: MD 32,000, CI –13,500–70,300; EMBSurgery: MD 16,200, CI –40,100–72,600). Subanalyses revealed significantly lower reintervention rates in the EMBSurgery group versus the surgery group (OR 0.34, CI 0.16–0.74; I² 0 %).

Conclusion

EMB combined with surgery seems to reduce reinterventions in cSDH compared to surgery alone with non significant complications that need further analysis through randomized trials with longer follow-ups.

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.