Embolization of the middle meningeal artery in patients with chronic subdural hematoma-a systematic review and meta-analysis
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Embolization of the middle meningeal artery in patients with chronic subdural hematoma-a systematic review and meta-analysis. / Haldrup, Mette; Ketharanathan, Baskaran; Debrabant, Birgit; Schwartz, Ole Sondergaard; Mikkelsen, Ronni; Fugleholm, Kare; Poulsen, Frantz Rom; Jensen, Thorbjorn Soren Ronn; Thaarup, Laerke Velia; Bergholt, Bo.
In: Acta Neurochirurgica, Vol. 162, 2020, p. 777-784.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - Embolization of the middle meningeal artery in patients with chronic subdural hematoma-a systematic review and meta-analysis
AU - Haldrup, Mette
AU - Ketharanathan, Baskaran
AU - Debrabant, Birgit
AU - Schwartz, Ole Sondergaard
AU - Mikkelsen, Ronni
AU - Fugleholm, Kare
AU - Poulsen, Frantz Rom
AU - Jensen, Thorbjorn Soren Ronn
AU - Thaarup, Laerke Velia
AU - Bergholt, Bo
PY - 2020
Y1 - 2020
N2 - Background Chronic subdural hematoma (CSDH) remains a neurosurgical condition with high recurrence rate after surgical treatment. The primary pathological mechanism is considered to be repeated microbleedings from fragile neo-vessels within the outer hematoma membrane. The neo-vessels are supplied from peripheral branches of the middle meningeal artery, and embolization of MMA (eMMA) has been performed to prevent re-bleeding episodes and thereby CSDH recurrence. Objective To evaluate the published evidence for the effect of eMMA in patients with recurrent CSDH. Secondarily, to investigate the effect of eMMA as an alternative to surgery for primary treatment of CSDH. Method A systematic review of the literature on eMMA in patients with recurrent CSDH was conducted. PubMed, Embase, and Cochrane databases were reviewed using the search terms: Embolization, Medial Meningeal Artery, Chronic Subdural Haematoma, and Recurrence. Furthermore, the following mesh terms were used: Chronic Subdural Haematoma AND embolization AND medial meningeal artery AND recurrence. Eighteen papers were found and included. No papers were excluded. The number of patients with primary CSDH and the number of patients with recurrent CSDH treated with eMMA were listed. Furthermore, the number of recurrences in both categories was registered. Results Eighteen papers with a total of 191 included patients diagnosed with CSDH treated with eMMA for primary and recurrent CSDH were identified. Recurrence rate for patients treated with eMMA for recurrent CSDH was found to be 2.4%, 95% CI (0.5%; 11.0%), whereas the recurrence rate for patients treated with eMMA for primary CSDH was 4.1%, 95% CI (1.4%; 11.4%). Conclusion eMMA is a minimally invasive procedure for treatment of CSDH. Although this study is limited by publication bias, it seems that this procedure may reduce recurrence rates compared with burr hole craniostomy for both primary and recurrent hematomas. A controlled study is warranted.
AB - Background Chronic subdural hematoma (CSDH) remains a neurosurgical condition with high recurrence rate after surgical treatment. The primary pathological mechanism is considered to be repeated microbleedings from fragile neo-vessels within the outer hematoma membrane. The neo-vessels are supplied from peripheral branches of the middle meningeal artery, and embolization of MMA (eMMA) has been performed to prevent re-bleeding episodes and thereby CSDH recurrence. Objective To evaluate the published evidence for the effect of eMMA in patients with recurrent CSDH. Secondarily, to investigate the effect of eMMA as an alternative to surgery for primary treatment of CSDH. Method A systematic review of the literature on eMMA in patients with recurrent CSDH was conducted. PubMed, Embase, and Cochrane databases were reviewed using the search terms: Embolization, Medial Meningeal Artery, Chronic Subdural Haematoma, and Recurrence. Furthermore, the following mesh terms were used: Chronic Subdural Haematoma AND embolization AND medial meningeal artery AND recurrence. Eighteen papers were found and included. No papers were excluded. The number of patients with primary CSDH and the number of patients with recurrent CSDH treated with eMMA were listed. Furthermore, the number of recurrences in both categories was registered. Results Eighteen papers with a total of 191 included patients diagnosed with CSDH treated with eMMA for primary and recurrent CSDH were identified. Recurrence rate for patients treated with eMMA for recurrent CSDH was found to be 2.4%, 95% CI (0.5%; 11.0%), whereas the recurrence rate for patients treated with eMMA for primary CSDH was 4.1%, 95% CI (1.4%; 11.4%). Conclusion eMMA is a minimally invasive procedure for treatment of CSDH. Although this study is limited by publication bias, it seems that this procedure may reduce recurrence rates compared with burr hole craniostomy for both primary and recurrent hematomas. A controlled study is warranted.
KW - Chronic subdural hematoma
KW - Embolization
KW - Medial meningeal artery
KW - Burr hole
KW - Craniotomy
KW - Recurrence rate
KW - Meta-analysis
KW - INDEPENDENT PREDICTORS
KW - RECURRENCE
U2 - 10.1007/s00701-020-04266-0
DO - 10.1007/s00701-020-04266-0
M3 - Review
C2 - 32086603
VL - 162
SP - 777
EP - 784
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
SN - 0001-6268
ER -
ID: 252727324