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.

中文翻译：

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慢性硬膜下血肿患者脑膜中动脉栓塞的系统评价和荟萃分析。

背景慢性硬膜下血肿（CSDH）仍然是一种神经外科疾病，手术治疗后复发率高。主要病理机制被认为是外血肿膜内脆弱的新血管反复微出血。新血管由脑膜中动脉的外周分支供血，并且已经进行了 MMA 栓塞 (eMMA) 以防止再出血发作，从而防止 CSDH 复发。目的 评估 eMMA 对复发性 CSDH 患者的影响的已发表证据。其次，研究 eMMA 作为 CSDH 初级治疗替代手术的效果。方法 对复发性 CSDH 患者 eMMA 的文献进行系统回顾。使用搜索词审查 PubMed、Embase 和 Cochrane 数据库：栓塞、内侧脑膜动脉、慢性硬膜下血肿和复发。此外，还使用了以下网格术语：慢性硬膜下血肿和栓塞和脑膜内侧动脉和复发。发现并收录了 18 篇论文。没有论文被排除在外。列出了原发性 CSDH 患者数和 eMMA 治疗的复发性 CSDH 患者数。此外，还记录了两个类别的复发次数。结果 确定了 18 篇论文，共 191 篇，包括诊断为 CSDH 的患者，这些患者接受 eMMA 治疗原发性和复发性 CSDH。发现用 eMMA 治疗复发性 CSDH 患者的复发率为 2.4%, 95% CI (0.5%; 11.0%)，而用 eMMA 治疗原发性 CSDH 患者的复发率为 4.1%, 95% CI (1.4%) ; 11.4%)。结论 eMMA 是一种治疗 CSDH 的微创手术。尽管这项研究受到发表偏倚的限制，但与颅骨钻孔术相比，这种手术似乎可以降低原发性和复发性血肿的复发率。有必要进行对照研究。