Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Barrow Neurological Institute, Phoenix, Arizona, USA.
J Neurointerv Surg. 2021 Jul;13(7):657-660. doi: 10.1136/neurintsurg-2020-016552. Epub 2020 Oct 19.
Recently, middle meningeal artery (MMA) embolization has emerged as a potentially safe and effective method of treating chronic subdural hematoma (cSDH).
To report a single-center experience with MMA embolization and examines the type of embolic material used, the extent of penetration, and the number of MMA branches embolized.
A retrospective analysis of all patients with MMA embolization from 2018 through 2019 was performed. A failed outcome was defined as either surgical rescue and/or greater than 10 mm of hematoma residual or reaccumulation following embolization.
Of 35 patients, surgery had failed for 9 (26%) and initial conservative treatment had failed for 6 (17%). Of 41 MMA embolizations, including those in six patients with bilateral cSDH who underwent bilateral MMA embolization, 29 (72%) were performed using ethylene vinyl alcohol copolymer (Onyx), 7 (17%) using particles, and 5 (12%) using n-butyl cyanoacrylate. Both the anterior and posterior MMA divisions were embolized in 29 cases (71%); distal penetration of these branches was achieved in 25 embolizations (61%). Twenty-six (63%) cSDHs completely resolved. Complete resolution was seen in 22 of 29 hematomas (76%) in which both anterior and posterior MMA branches were occluded versus 4 of 12 (33%) following single-branch embolization (p=0.014). Embolization of one cSDH (2%) failed.
MMA embolization of cSDHs appears to be both safe and efficacious. Furthermore, embolization of both the anterior and posterior MMA branches may be associated with increased odds of complete resolution.
最近，中脑膜动脉（MMA）栓塞已成为治疗慢性硬脑膜下血肿（cSDH）的一种潜在安全有效的方法。
报告一个 MMA 栓塞的单中心经验，并检查使用的栓塞材料的类型、穿透程度和栓塞的 MMA 分支数量。
对 2018 年至 2019 年期间所有接受 MMA 栓塞治疗的患者进行回顾性分析。失败结果定义为栓塞后手术救援和/或血肿残留大于 10mm 或再积聚。
35 例患者中，9 例（26%）手术失败，6 例（17%）初始保守治疗失败。41 例 MMA 栓塞术，包括 6 例双侧 cSDH 患者行双侧 MMA 栓塞术，29 例（72%）采用乙烯-乙烯醇共聚物（Onyx），7 例（17%）采用颗粒，5 例（12%）采用 n-丁基氰基丙烯酸酯。29 例（71%）同时栓塞前、后 MMA 分支，25 例（61%）达到这些分支的远端穿透。26 例（63%）cSDH 完全消退。22 例（76%）前、后 MMA 分支均闭塞的血肿完全消退，而 12 例（33%）单支栓塞的血肿完全消退（p=0.014）。1 例（2%）cSDH 栓塞失败。
MMA 栓塞治疗 cSDH 似乎既安全又有效。此外，栓塞前、后 MMA 分支可能与完全消退的几率增加有关。
