СОВРЕМЕННЫЕ СТРАТЕГИИ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ХРОНИЧЕСКОЙ СУБДУРАЛЬНОЙ ГЕМАТОМЫ: РОЛЬ ЭМБОЛИЗАЦИИ СРЕДНЕЙ МЕНИНГЕАЛЬНОЙ АРТЕРИИ В ПРОФИЛАКТИКЕ РЕЦИДИВОВ

Abstract

Background. Chronic subdural hematoma (CSDH) is a common neurosurgical disorder predominantly affecting older adults. Although burr-hole evacuation with postoperative drainage remains an established treatment, recurrence continues to represent a significant clinical problem. Advances in understanding inflammation, angiogenesis, local fibrinolysis, and pathological vascularization of the outer hematoma membrane have provided a rationale for middle meningeal artery embolization.

Objective. To analyze contemporary surgical and endovascular treatment strategies for chronic subdural hematoma and develop an individualized clinical decision-making framework integrating neurological status, imaging characteristics, and recurrence risk factors.

Materials and Methods. A narrative analytical review of randomized clinical trials, systematic reviews, meta-analyses, and international recommendations was conducted. Particular attention was given to EMBOLISE, MAGIC-MT, STEM, EMMA-Can, MEMBRANE, FINISH, and DRAIN TIME 2.

Results. Evidence concerning burr-hole evacuation, intraoperative irrigation, postoperative drainage, and middle meningeal artery embolization was synthesized. An original conceptual decision framework, CSDH-STRAT, was developed to integrate mass effect, clinical deterioration, hematoma morphology, recurrence risk, and endovascular feasibility.

Conclusion. Surgical decompression remains essential in symptomatic chronic subdural hematoma associated with clinically significant mass effect. Adjunctive middle meningeal artery embolization offers an evidence-based opportunity to reduce recurrence in appropriately selected patients. Further studies are required to optimize patient selection and determine the most effective treatment combinations.