Department of Neurosurgery, Weill Cornell Medical College, New York Pres-byterian Hospital, New York, New York.
Department of Pathology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
Oper Neurosurg (Hagerstown). 2018 May 1;14(5):556-562. doi: 10.1093/ons/opx154.
Traditional treatment for symptomatic subdural hematoma (SDH) has been surgical evacuation, but recurrence rates are high and patients often harbor complex medical comorbidities. Growth and recurrence is thought to be due to the highly friable nature of the vascularized membrane that forms after initial injury. There have been reported cases of middle meningeal artery (MMA) embolization for treatment of recurrent SDH after surgical evacuation with the goal of eliminating the arterial supply to this vascularized membrane.
To present the first known case series of MMA embolization as upfront treatment for symptomatic chronic SDHs that have failed conservative management in lieu of surgical evacuation.
Five patients with symptomatic chronic SDHs underwent MMA embolization using PVA microparticles at our institution. Size of SDH was recorded in maximum diameter and total volume.
Four patients underwent unilateral and 1 underwent bilateral MMA embolization successfully. All cases had significant reduction in total volume of SDH at longest follow-up scan: 81.4 to 13.8 cc (7 wk), 48.5 to 8.7 cc (3 wk), 31.7 and 88 to 0 and 17 cc (14 wk, bilateral), 79.3 to 24.2 cc (8 wk), and 53.5 to 0 cc (6 wk). All patients had symptomatic relief with no complications. Histologic analysis of the chronic SDH membrane in a separate patient that required surgery revealed rich neovascularization with many capillaries and few small arterioles.
MMA embolization could present a minimally invasive and low-risk initial treatment alternative to surgery for symptomatic chronic SDH when clinically appropriate.
传统治疗症状性硬膜下血肿（SDH）的方法是手术清除，但复发率较高，且患者常伴有复杂的合并症。认为血管化膜的高度脆弱性是导致初始损伤后生长和复发的原因。已有报道称，中脑膜动脉（MMA）栓塞术可用于治疗手术清除后复发性 SDH，其目的是消除这种血管化膜的动脉供应。
报告首例 MMA 栓塞术作为治疗症状性慢性 SDH 的一线治疗方法，这些 SDH 在保守治疗失败后无需手术清除。
我院对 5 例症状性慢性 SDH 患者进行 MMA 栓塞术，采用 PVA 微球。记录 SDH 的最大直径和总体积。
4 例患者行单侧 MMA 栓塞术，1 例患者行双侧 MMA 栓塞术。所有病例在最长随访扫描时 SDH 的总体积均有明显减少：81.4 至 13.8 cc（7 周），48.5 至 8.7 cc（3 周），31.7 和 88 至 0 和 17 cc（14 周，双侧），79.3 至 24.2 cc（8 周），53.5 至 0 cc（6 周）。所有患者均有症状缓解，无并发症。对另一例需要手术的慢性 SDH 膜进行组织学分析显示，其富含新生血管，有许多毛细血管，少量小动脉。
当临床适用时，MMA 栓塞术可能是一种微创、低风险的治疗症状性慢性 SDH 的初始替代方法。
