Department of Neurosurgery, Schoen Clinic Vogtareuth, Vogtareuth, Bavaria, Germany
Department of Diagnostic and Interventionell Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Bavaria, Germany.
J Neurointerv Surg. 2022 Mar;14(3):297-300. doi: 10.1136/neurintsurg-2021-017450. Epub 2021 Jun 29.
Chronic subdural hematoma (CSDH) is a common neurosurgical condition with high recurrence rates. Repeated microbleedings from fragile neo-vessels supplied by peripheral branches of the middle meningeal artery (MMA) are believed to be responsible for the growth and recurrence of CSDH. Thus, MMA embolization might be a promising method to prevent re-bleedings and recurrences. This study aims to assess the efficacy, complication rates, and mid-term outcome of MMA embolization with or without burr hole irrigation compared with burr hole irrigation alone.
Patients diagnosed with CSDH who underwent MMA embolization and/or surgical treatment were retrospectively recruited to this single-center study. The outcome variables were defined as treatment-related complications, clinical outcome at discharge, rate of revision surgery, and CT findings during the follow-up period.
A total of 132 patients with CSDH were included in the study. The use of antiplatelet/anticoagulant medication was significantly higher in the combined treatment and embolization group (p<0.001). A trend towards fewer revision surgeries was found in the group of patients who received MMA embolization combined with burr hole irrigation (p=0.083). Follow-up was available for 73 patients (55.3%) with a mean follow-up period of 3.4±2.2 months. Eight patients (15.1%) of the surgery group showed hematoma re-accumulation and needed surgical rescue, whereas only one patient (5.0%) of the combined treatment group needed revision surgery. In all patients treated with only MMA embolization, complete hematoma resolution was found.
MMA embolization is a safe and efficacious minimal invasive adjuvant and/or alternative procedure for the treatment of CSDH with a reduced recurrence rate.
慢性硬脑膜下血肿（CSDH）是一种常见的神经外科疾病，复发率较高。人们认为，由脑膜中动脉（MMA）外周分支供应的脆弱新生血管反复微出血是 CSDH 生长和复发的原因。因此，MMA 栓塞可能是预防再出血和复发的一种有前途的方法。本研究旨在评估 MMA 栓塞联合或不联合颅骨钻孔冲洗与单纯颅骨钻孔冲洗相比的疗效、并发症发生率和中期结果。
本单中心回顾性研究纳入了诊断为 CSDH 并接受 MMA 栓塞和/或手术治疗的患者。观察指标为治疗相关并发症、出院时的临床结局、翻修手术率以及随访期间的 CT 发现。
共纳入 132 例 CSDH 患者。联合治疗和栓塞组抗血小板/抗凝药物的使用明显更高（p<0.001）。MMA 栓塞联合颅骨钻孔冲洗组的翻修手术率呈下降趋势（p=0.083）。73 例（55.3%）患者获得随访，平均随访时间为 3.4±2.2 个月。手术组 8 例（15.1%）患者血肿再次积聚，需要手术挽救，而联合治疗组仅 1 例（5.0%）患者需要翻修手术。所有接受单纯 MMA 栓塞治疗的患者均发现血肿完全消退。
MMA 栓塞是治疗 CSDH 的一种安全有效的微创辅助治疗和/或替代方法，复发率降低。
