Middle meningeal artery embolization for chronic subdural hematoma: a systematic review and meta-analysis.

Autor:	Ironside N; Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA., Nguyen C; Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA., Do Q; Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA., Ugiliweneza B; Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA., Chen CJ; Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA., Sieg EP; Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA., James RF; Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA., Ding D; Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA daleding1234@gmail.com.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2021 Oct; Vol. 13 (10), pp. 951-957. Date of Electronic Publication: 2021 Jun 30.
DOI:	10.1136/neurintsurg-2021-017352
Abstrakt:	Middle meningeal artery (MMA) embolization has been proposed as a minimally invasive treatment for chronic subdural hematoma (cSDH). The aim of this systematic review and meta-analysis is to compare outcomes after MMA embolization versus conventional management for cSDH. We performed a systematic review of PubMed, Embase, Oxford Journal, Cochrane, and Google Scholar databases from April 1987 to October 2020 in accordance with PRISMA guidelines. Studies reporting outcomes after MMA embolization for ≥3 patients with cSDH were included. A meta-analysis comparing MMA embolization with conventional management was performed. The analysis comprised 20 studies with 1416 patients, including 718 and 698 patients in the MMA embolization and conventional management cohorts, respectively. The pooled recurrence, surgical rescue, and in-hospital complication rates in the MMA embolization cohort were 4.8% (95% CI 3.2% to 6.5%), 4.4% (2.8% to 5.9%), and 1.7% (0.8% to 2.6%), respectively. The pooled recurrence, surgical rescue, and in-hospital complication rates in the conventional management cohort were 21.5% (0.6% to 42.4%), 16.4% (5.9% to 27.0%), and 4.9% (2.8% to 7.1%), respectively. Compared with conservative management, MMA embolization was associated with lower rates of cSDH recurrence (OR=0.15 (95% CI 0.03 to 0.75), p=0.02) and surgical rescue (OR=0.21 (0.07 to 0.58), p=0.003). In-hospital complication rates were comparable between the two cohorts (OR=0.78 (0.34 to 1.76), p=0.55). MMA embolization is a promising minimally invasive therapy that may reduce the need for surgical intervention in appropriately selected patients with cSDH. Additional prospective studies are warranted to determine the long-term durability of MMA embolization, refine eligibility criteria, and establish this endovascular approach as a viable definitive treatment for cSDH. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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