脑膜中动脉干预联合术式治疗慢性硬膜下血肿的研究进展

Research Progress of Middle Meningeal Artery Intervention Combined with Surgical Treatment for Chronic Subdural Hematoma

摘要: 慢性硬膜下血肿(chronic subdural hematoma, CSDH)是神经外科中的常见疾病，好发于老年人群，随着人口老龄化程度增加，以及抗凝与抗血小板药物的普及，慢性硬膜下血肿的发病率逐年增高。CSDH起病隐匿、临床表现多样，传统以钻孔引流术作为主要治疗手段，但术后复发率较高，对患者预后产生了极大的影响。近年来相关研究表明，脑膜中动脉(middle meningeal artery, MMA)作为血肿外膜新生血管的主要供应血管，其持续渗出是导致血肿扩大及术后复发的重要因素。以脑膜中动脉为干预目标的治疗方式逐渐成为研究重点，主要包括脑膜中动脉栓塞术(middle meningeal artery embolization, EMMA)、钻孔引流联合脑膜中动脉离断术以及神经内镜手术联合脑膜中动脉离断术。本文围绕脑膜中动脉在慢性硬膜下血肿发生与进展中的作用、各类术式的操作要点、适用人群及临床疗效进行综述，比较不同联合术式的特点与差异，以及对当前治疗方案存在问题及未来研究方向进行总结，为临床治疗提供理论依据。

Abstract: Chronic subdural hematoma (CSDH) is a common disease in neurosurgery, which occurs in the elderly population. With the increase of population aging and the popularization of anticoagulant and antiplatelet drugs, the incidence of CSDH is increasing year by year. CSDH has insidious onset and diverse clinical manifestations. Traditionally, drilling and drainage is the main treatment method, but the recurrence rate is high, which has a great impact on the prognosis of patients. In recent years, relevant studies have shown that the middle meningeal artery (MMA), as the main supply vessel of neovascularization in the outer membrane of hematoma, whose continuous exudation is an important factor leading to hematoma enlargement and postoperative recurrence. The treatment methods with middle meningeal artery as the target of intervention have gradually become the focus of research, mainly including middle meningeal artery embolization (EMMA), drilling and drainage combined with middle meningeal artery disconnection, and neuroendoscopic surgery combined with middle meningeal artery disconnection. This article reviews the role of middle meningeal artery in the occurrence and progression of chronic subdural hematoma, the operation points, applicable population and clinical efficacy of various surgical procedures, compares the characteristics and differences of different combined surgical procedures, and summarizes the existing problems and future research directions of the current treatment plan, so as to provide theoretical basis for clinical treatment.