慢性硬膜下血肿联合治疗的时机与方式 优化策略

Timing and Method Optimization Strategies for Combined Treatment of Chronic Subdural Hematoma

摘要: 慢性硬膜下血肿(chronic subdural hematoma, cSDH)是神经外科常见疾病，钻孔引流(burr hole drainage, BHD)术后复发率较高。脑膜中动脉栓塞术(middle meningeal artery embolization, MMAE)通过阻断血肿包膜血供，为降低复发与再手术风险提供了新策略。本综述系统梳理了MMAE联合BHD或单独应用的优化证据：联合治疗可降低复发风险约50%且不增加严重并发症，但其获益因亚组而异；术前栓塞可能降低再手术率，同期联合可缩短住院时间；液体栓塞剂渗透优势明显但成本高，颗粒性价比更优；经桡动脉入路对高龄患者有益；MMAE支持安全早期重启抗栓治疗，他汀等辅助药物在现有研究中未显示额外临床获益。综上，MMAE联合BHD能有效降低cSDH复发与再干预风险，但获益具有明显异质性，未来需开展高质量研究明确最佳适用场景。

Abstract: Chronic subdural hematoma (cSDH) is a common neurosurgical disease, and the recurrence rate after burr hole drainage (BHD) is high. Middle meningeal artery embolization (MMAE), which blocks the blood supply to the hematoma membrane, offers a new strategy to reduce the risk of recurrence and reoperation. This review systematically synthesizes evidence on the optimization of MMAE combined with BHD or as a standalone treatment: combination therapy reduces the recurrence risk by approximately 50% without increasing major complications, but the benefit varies by patient subgroup. Preoperative embolization may reduce the reoperation rate, while concurrent combination shortens hospital stay. Liquid embolic agents have advantages in penetration but are costly, whereas particles are more cost-effective. Transradial access is beneficial for elderly patients. MMAE supports safe and early resumption of antithrombotic therapy, while adjunctive drugs such as statins have shown no additional clinical benefit in existing studies. In summary, MMAE combined with BHD effectively reduces the risk of recurrence and reintervention in cSDH, but the benefit is markedly heterogeneous. Future high-quality studies are needed to define the optimal clinical scenarios for its application.