Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC, USA.
Department of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, PHC7, Washington, DC, USA.
Neurosurg Rev. 2022 Feb;45(1):439-449. doi: 10.1007/s10143-021-01553-x. Epub 2021 Apr 24.
Optimal treatment for chronic subdural hematomas remains controversial and perioperative risks and comorbidities may affect management strategies. Minimally invasive procedures are emerging as alternatives to the standard operative treatments. We evaluate our experience with middle meningeal artery (MMA) embolization combined with Subdural Evacuating Port System (SEPS) placement as a first-line treatment for patients with cSDH. A single institution retrospective review was performed of all patients undergoing intervention. Patients were stratified by treatment with MMA embolization and SEPS placement, MMA embolization and surgery, SEPS placement only, and surgery only for cSDH from 2017 to 2020, and cohorts were compared against each other. Patients treated with MMA/SEPS were more likely to be older, be on anticoagulation, have significant comorbidities, have shorter length of stay, and less likely to have symptomatic recurrence compared to SEPS only cohort. Thus, MMA/SEPS appears to be a safe and equally effective minimally invasive treatment for cSDH patients with significant comorbidities who are poor surgical candidates.
慢性硬脑膜下血肿的最佳治疗方法仍存在争议，围手术期的风险和合并症可能会影响治疗策略。微创治疗方法正在成为标准手术治疗的替代方法。我们评估了我们使用脑膜中动脉（MMA）栓塞联合硬脑膜下引流系统（SEPS）放置作为慢性硬脑膜下血肿患者一线治疗的经验。对 2017 年至 2020 年间所有接受介入治疗的患者进行了单一机构回顾性研究。根据 MMA 栓塞和 SEPS 放置、MMA 栓塞和手术、仅 SEPS 放置以及仅手术治疗慢性硬脑膜下血肿，对患者进行分层，并对各个队列进行比较。与仅接受 SEPS 治疗的患者相比，接受 MMA/SEPS 治疗的患者年龄更大、正在服用抗凝药物、合并症更多、住院时间更短、症状复发的可能性更小。因此，MMA/SEPS 似乎是一种安全且同样有效的微创治疗方法，适用于合并症严重且不适合手术的慢性硬脑膜下血肿患者。
