Non acute subdural hematoma is one of the common and challenging neurosurgical diseases in clinical practice. With the progress of aging, its high incidence rate, high disability rate and high recurrence rate are clinical problems facing the world. Recently, the top international medical academic journal, the New England Journal of Medicine, released research results jointly completed by the Shanghai Shenkang Hospital Development Center, the National Center for Neurological Diseases (Huashan), and the Military Cerebrovascular Disease Research Institute (Changhai), led by Professor Mao Ying's team from Huashan Hospital affiliated with Fudan University and Professor Liu Jianmin's team from the First Affiliated Hospital of Naval Medical University, and 31 neurosurgery and cerebrovascular disease centers in China. This study has successfully provided a new method for treating non acute subdural hematoma worldwide: middle meningeal artery embolization. This study is the largest randomized controlled trial (RCT) in the world with the same sample size for the treatment of non acute subdural hematoma with middle meningeal artery embolization. With high scientific rigor and clinical significance, it provides important reference for the treatment plan of similar patients worldwide. The release of the results also marks a significant breakthrough in clinical research in neurosurgery in China, becoming an important leader and collaborator in the international field. Research has shown that compared to traditional treatment alone, adjuvant middle meningeal artery embolization combined with traditional treatment can significantly reduce the hematoma progression rate in symptomatic non acute subdural hematoma patients who do not require drilling; When including patients with neurological related deaths caused by hematoma recurrence or progression as the primary endpoint, adjuvant middle meningeal artery embolization can significantly reduce the recurrence and progression rates of all symptomatic non acute subdural hematoma patients. Mao Ying explained that common causes of non acute subdural hematoma include trauma, long-term use of anticoagulants and antiplatelet drugs, and repeated or sudden increases in chest and abdominal pressure. When the hematoma enlarges and causes an increase in intracranial pressure, patients may experience symptoms such as headache, dizziness, or limb movement disorders, and even frequent vomiting, deep coma, and life-threatening situations. Traditional non acute subdural hematoma treatment methods include drilling and drainage surgery and drug therapy. Although they have been proven effective, the recurrence rate of traditional drilling and drainage is as high as 12% to 20%, while conservative drug treatment has a longer recovery period and greater uncertainty. Under this demand, the technique of middle meningeal artery embolization has emerged. Middle meningeal artery embolization refers to the use of minimally invasive intervention techniques to inject embolic substances (such as liquid embolic agents or particles) into the main trunk or branches of the middle meningeal artery. By embolization of the middle meningeal artery, blood supply is blocked from the source, thereby reducing the blood supply to the hematoma, gradually absorbing the blood inside the hematoma, and promoting hematoma shrinkage; Meanwhile, this method can prevent the injection of fresh blood and reduce the risk of further hematoma enlargement. This minimally invasive and precise treatment method can technically reduce the trauma of traditional surgery and minimize damage to surrounding normal tissues; At the same time, the principle of reducing hematoma regeneration and progression by embolization of blood supply vessels has received high attention from neurologists worldwide, but its efficacy has not been supported by high-level evidence. Based on this significant clinical need, a prospective, multicenter, randomized controlled trial (MAGIC-MT) was officially launched in 2020 to comprehensively evaluate the safety and efficacy of this treatment method. The study was conducted in 31 sub centers in 12 provinces and cities in China, and the enrolled patients were symptomatic non acute subdural hematoma patients. The research team conducted strict screening and training for participating centers and surgeons, using standardized drilling drainage and middle meningeal artery embolization treatment methods to strengthen the comprehensive management level during the perioperative period. This study not only provides new treatment ideas for the field of neurosurgery, but also opens up new directions for the understanding of neurological diseases, which will further promote the development of neurointerventional therapy in neurosurgery and benefit more patients Liu Jianmin said. (New Society)
Edit：Yao jue Responsible editor：Xie Tunan
Source：GMW.cn
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