陆军军医大学学报2026，Vol.48Issue(17)：2381-2389,9.DOI:10.16016/j.2097-0927.202604089
慢性硬膜下血肿介入治疗进展:从辅助治疗迈向一线治疗之路
Advances in endovascular therapy for chronic subdural hematoma:from adjunctive treatment toward first-line therapy
摘要
Abstract
Chronic subdural hematoma(CSDH)is one of the most prevalent conditions in neurosurgical practice.Its incidence continues to rise in the context of global population aging and the widespread use of anticoagulant and antiplatelet medications.Although conventional burr-hole drainage is the most widely adopted approach,its recurrence rates remain considerable high,and surgical tolerance is poor in elderly patients.Therefore,we should underscore the urgent need to reassess clinical strategies for this disease.Middle meningeal artery embolization(MMAE)exerts a therapeutic effect by interrupting the blood supply to the hematoma capsule,thereby targeting the pathological source of disease progression.In particular,4 recent large-scale multicenter randomized controlled trials(EMBOLISE,MAGIC-MT,STEM,and EMPROTECT)have preliminary provided evidence-based validation of the safety and efficacy of MMAE.The clinical benefit of MMAE is particularly pronounced in symptomatic patients without emergency surgical indications,those on anticoagulant/antiplatelet therapy,patients with recurrent hematoma,and those at high surgical risk.Meanwhile,perioperative multimodality imaging assessment of the architecture of feeding arteries and the perfusion of hematoma capsule facilitates the prediction for therapeutic efficacy,early warning of recurrence,and formulation of individualized embolization strategies.Technically,hybrid surgical approaches and transradial artery access provide safer treatment options for high-risk patients,while the selection of embolic materials varies according to specific clinical scenarios.Based on the evolving evidence and clinical experience in MMAE,we propose a core conceptual advancement in the endovascular treatment of CSDH which is a shift from isolated middle meningeal artery embolization toward precise embolization of the hematoma capsule arterial supply under the guidance of imaging assessment of capsule blood supply,thereby achieving the goal of precise and effective individualized treatment.关键词
慢性硬膜下血肿/脑膜中动脉栓塞/血肿包膜血供/患者分层/个体化治疗Key words
chronic subdural hematoma/middle meningeal artery embolization/blood supply for hematoma capsule/patient stratification/individualized therapy分类
医药卫生引用本文复制引用
陈志,李文䶮..慢性硬膜下血肿介入治疗进展:从辅助治疗迈向一线治疗之路[J].陆军军医大学学报,2026,48(17):2381-2389,9.基金项目
创伤与化学中毒全国重点实验室开放基金(SKLO202505) （SKLO202505）
陆军军医大学红医苗圃人才项目 Supported by the Open Fund of State Key Laboratory of Trauma and Chemical Poisoning(SKLO202505),and the Red Medical Nursery Talent Program of Army Medical University. （SKLO202505）
