Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurosurgery, Cooper University Hospital, Camden, New Jersey, USA.
World Neurosurg. 2022 Sep;165:e581-e587. doi: 10.1016/j.wneu.2022.06.099. Epub 2022 Jun 26.
Middle meningeal artery embolization (MMAE) is a novel approach for treatment of chronic subdural hematoma (cSDH). Studies comparing different procedural techniques for MMAE are lacking. It is unclear whether isolated use of coils results in suboptimal outcomes compared to when particle embolization is also performed. The objectives of this study are to describe the outcomes of coil-only MMAE and compare them with those of combined use of coils and particles.
A single-institution retrospective study of cSDH cases treated by MMAE was performed. Clinical outcomes, need for rescue surgery, and changes in hematoma's size were compared between the coil-only and coil + particle groups.
Ninety-four hematomas in 78 patients were included. Twelve cases were treated by a coil-only MMAE procedure, often due to presence of dangerous ophthalmic collaterals. No treatment-related complications were observed in the coil-only group. There was no significant difference between the coil-only and coil + particle groups in baseline hematoma axial thickness, volume, midline shift, and duration of follow-up. The rate of need for rescue surgery was similar between the 2 groups (8.3% vs. 8.5%; P = 0.98). Coiling alone resulted in a similar percentage of reduction in cSDH volume (68.3% vs. 71.8%; P = 0.8) and rate of achieving ≥50% reduction in volume (81.8% vs. 76.3%; P = 0.68) compared to coils + particles.
Isolated use of coils for endovascular treatment of cSDHs can be as effective as adjunct use of particle embolization. This method eliminates the risks of cranial nerve and visual complications associated with MMAE, can prevent procedural abortion due to presence of dangerous anastomoses, and reduces the technical complexity of the procedure.
中脑膜动脉栓塞术（MMAE）是治疗慢性硬脑膜下血肿（cSDH）的一种新方法。缺乏比较不同手术技术的研究。目前尚不清楚与同时进行颗粒栓塞相比，单独使用线圈是否会导致结果不理想。本研究的目的是描述仅使用线圈的 MMAE 的结果，并将其与联合使用线圈和颗粒的结果进行比较。
对通过 MMAE 治疗的 cSDH 病例进行了单中心回顾性研究。比较了仅线圈组和线圈+颗粒组之间的临床结果、需要挽救性手术的情况以及血肿大小的变化。
共纳入 78 例患者的 94 个血肿。12 例因存在危险的眼动脉吻合支而采用仅线圈 MMAE 治疗。仅线圈组未观察到与治疗相关的并发症。仅线圈组和线圈+颗粒组在基线血肿轴厚、体积、中线移位和随访时间方面无显著差异。两组的挽救性手术率相似（8.3%对 8.5%；P=0.98）。单独使用线圈治疗后，cSDH 体积减少的比例（68.3%对 71.8%；P=0.8）和体积减少≥50%的比例（81.8%对 76.3%；P=0.68）与线圈+颗粒相似。
血管内治疗 cSDH 时单独使用线圈可以与颗粒栓塞联合使用一样有效。这种方法消除了 MMAE 相关的颅神经和视觉并发症的风险，可以防止因存在危险吻合支而导致手术失败，并降低手术的技术复杂性。
