From the Department of Neurosurgery (F.A.-M., G.K., J.B.C., K.D., J.P., C.M., R.T., C.C., J.S., C.G.), New York Medical College, Westchester Medical Center, Valhalla, New York.
Department of Neurointerventional Radiology (K.A.), Goodman Campbell Brain and Spine, Carmel, Indiana.
AJNR Am J Neuroradiol. 2021 May;42(5):916-920. doi: 10.3174/ajnr.A7077. Epub 2021 Mar 4.
Embolization of the middle meningeal artery for treatment of refractory or recurrent chronic subdural hematomas has gained momentum during the past few years. Little has been reported on the use of the -BCA liquid embolic system for middle meningeal artery embolization. We present the technical feasibility of using diluted -BCA for middle meningeal artery embolization.
We sought to examine the safety and technical feasibility of the diluted -BCA liquid embolic system for middle meningeal artery embolization. Patients with chronic refractory or recurrent subdural hematomas were prospectively enrolled from September 2019 to June 2020. The primary outcome was the safety and technical feasibility of the use of diluted -BCA for embolization of the middle meningeal artery. The secondary end point was the efficacy in reducing hematoma volume.
A total of 16 patients were prospectively enrolled. Concomitant burr-hole craniotomies were performed in 12 of the 16 patients. Two patients required an operation following middle meningeal artery embolization for persistent symptoms. The primary end point was met in 100% of cases in which there were no intra- or postprocedural complications. Distal penetration of the middle meningeal artery branches was achieved in all the enrolled cases. A 7-day post-middle meningeal artery embolization follow-up head CT demonstrated improvement (>50% reduction in subdural hematoma volume) in 9/15 (60%) patients, with 6/15 (40%) showing an unchanged or stable subdural hematoma. At day 21, available CT scans demonstrated substantial further improvement (>75% reduction in subdural hematoma volume).
Embolization of the middle meningeal artery using diluted -BCA and ethiodized oil (1:6) is safe and feasible from a technical standpoint. The use of a dextrose 5% bolus improves distal penetration of the glue.
近年来，对于难治性或复发性慢性硬膜下血肿，采用中脑膜动脉栓塞术治疗已逐渐普及。关于使用 -BCA 液体栓塞系统进行中脑膜动脉栓塞的报道较少。我们介绍了使用稀释的 -BCA 进行中脑膜动脉栓塞的技术可行性。
我们旨在检查稀释的 -BCA 液体栓塞系统用于中脑膜动脉栓塞的安全性和技术可行性。2019 年 9 月至 2020 年 6 月，前瞻性地招募了患有慢性难治性或复发性硬膜下血肿的患者。主要结局是使用稀释的 -BCA 进行中脑膜动脉栓塞的安全性和技术可行性。次要终点是减少血肿体积的疗效。
共前瞻性纳入 16 例患者。在 16 例患者中，有 12 例同时进行了颅骨钻孔术。2 例患者在中脑膜动脉栓塞后因持续症状而行手术治疗。在没有术中或术后并发症的情况下，主要终点在所有病例中均达到 100%。所有纳入的病例均实现了中脑膜动脉分支的远端穿透。在中脑膜动脉栓塞后 7 天的头部 CT 随访中，15 例中有 9 例（60%）的硬膜下血肿体积减少>50%，其中 6 例（40%）的硬膜下血肿体积不变或稳定。在第 21 天，可获得的 CT 扫描显示进一步显著改善（硬膜下血肿体积减少>75%）。
从技术角度来看，使用稀释的 -BCA 和碘化油（1:6）栓塞中脑膜动脉是安全且可行的。使用 5%葡萄糖液团块可改善胶的远端穿透。
