School of Medicine, New York Medical College, Valhalla, NY, USA.
Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
J Clin Neurosci. 2021 Dec;94:70-75. doi: 10.1016/j.jocn.2021.10.001. Epub 2021 Oct 11.
Middle meningeal artery (MMA) embolization represents a promising novel treatment modality for chronic subdural hematoma (cSDH), yet utilization and efficacy data are limited. This study evaluates the utilization and short-term outcomes of MMA embolization for cSDH treatment in a large national inpatient registry. cSDH patients treated with MMA embolization and/or surgical evacuation (craniotomy/burr hole drainage) were identified using the National Inpatient Sample (NIS) during 2012-2018 period. Temporal trends, complications, and discharge disposition were evaluated, and propensity score matching was implemented for adjusted comparisons and to mitigate confounding by indication. Among 60,045 cSDH patients identified, 390 (0.6%) underwent MMA embolization. Embolized patients presented more with high acute illness severity subclasses in comparison with surgically evacuated patients (53% vs. 34%, p = 0.004) yet did not experience any procedure-related hemorrhagic or ischemic complications. Although discharge disposition did not differ from those surgically managed, embolized patients had longer mean hospital stays (13 vs. 8 days, p = 0.023) and accrued greater hospital charges (p < 0.001). Following propensity adjustment, length of stay and charges remained greater in the embolization cohort, yet rates of routine discharge increased appreciably (40% vs. 30%, p = 0.141) relative to surgically treated cSDH patients. The utilization of embolization increased exponentially after 2015, reaching an apex in 2018 (3.7% of treated cSDH). This population-based national assessment demonstrates exponential increases in utilization of MMA embolization for cSDH treatment in recent years. Embolized patients had uncomplicated clinical courses and similar discharge dispositions as surgical evacuation patients. Large-scale prospective trials are warranted to further assess the efficacy of this modality.
脑膜中动脉（MMA）栓塞术是一种有前途的慢性硬脑膜下血肿（cSDH）新的治疗方法，但利用和疗效数据有限。本研究评估了 MMA 栓塞术在大型全国住院患者登记处治疗 cSDH 的利用情况和短期结果。在 2012 年至 2018 年期间，使用国家住院患者样本（NIS）确定了接受 MMA 栓塞术和/或手术清除（开颅术/颅骨钻孔引流术）治疗的 cSDH 患者。评估了时间趋势、并发症和出院情况，并进行了倾向评分匹配，以进行调整比较和减轻指示性混杂。在确定的 60,045 例 cSDH 患者中，有 390 例（0.6%）接受了 MMA 栓塞术。与手术清除的患者相比，接受栓塞治疗的患者在急性疾病严重程度较高的亚组中表现更为突出（53% vs. 34%，p=0.004），但没有发生任何与手术相关的出血或缺血性并发症。尽管出院情况与手术治疗的患者没有差异，但栓塞治疗的患者平均住院时间更长（13 天 vs. 8 天，p=0.023），住院费用更高（p<0.001）。在进行倾向调整后，栓塞组的住院时间和费用仍然较大，但与手术治疗的 cSDH 患者相比，常规出院率显著增加（40% vs. 30%，p=0.141）。自 2015 年以来，栓塞术的使用率呈指数级增长，在 2018 年达到顶峰（治疗的 cSDH 的 3.7%）。这项基于人群的全国性评估表明，近年来 MMA 栓塞术治疗 cSDH 的使用率呈指数级增长。栓塞治疗的患者具有无并发症的临床过程和与手术清除患者相似的出院情况。需要进行大规模的前瞻性试验来进一步评估该方法的疗效。
