Acta neurochirurgica
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Acta neurochirurgica · Mar 2020
Meta AnalysisEfficacy and safety of middle meningeal artery embolization in the management of refractory or chronic subdural hematomas: a systematic review and meta-analysis.
Refractory or chronic subdural hematomas (cSDH) constitute a challenging entity that neurosurgeons face frequently nowadays. Middle meningeal artery embolization (MMAE) has emerged in the recent years as a promising treatment option. However, solid evidence that can dictate management guidelines is still lacking. ⋯ Although MMAE appears to be a promising treatment for refractory or cSDH, drawing definitive conclusions remains limited by paucity of data and small sample sizes. Multicenter, randomized, prospective trials are needed to compare embolization to conventional treatments like watchful waiting, medical management, or surgical evacuation. More extensive research on MMAE could begin a new era in the minimally invasive management of cSDH.
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The eyebrow incision supraorbital approach is limited by the lack of exposure of the sylvian fissure exposure. By extending the skin incision 15 mm posteriorly and the supraorbital craniotomy beneath the superior temporal line, proximal sylvian dissection is achievable, and the surgical exposure is drastically improved. ⋯ xEBA is a versatile technique that uses the pretemporal, transylvian, and subfrontal corridor to enhance surgical exposure around the anterior cranial fossa.