J Neurosurg. 2022 Dec 23;139(1):124-130. doi: 10.3171/2022.11.JNS222024. Print 2023 Jul 1.
Middle meningeal artery embolization (MMAE) is an emerging endovascular treatment technique with proven promising results for chronic subdural hematomas (cSDHs). MMAE as an adjunct to open surgery is being utilized with the goal of preventing the recurrence of cSDH. However, the efficacy of MMAE following surgical evacuation of cSDH has not been clearly demonstrated. The authors sought to compare the outcomes of open surgery followed by MMAE versus open surgery alone.
Patients who underwent surgical evacuation alone (open surgery-alone group) or MMAE along with open surgery for cSDH (adjunctive MMAE group) were identified at the authors' institution. Two balanced groups were obtained through propensity score matching. Primary outcomes included recurrence risk and reintervention rate. Secondary outcomes included decrease in hematoma size and modified Rankin Scale (mRS) score at last follow-up. Variables in the two groups were compared by use of the Mann-Whitney U-test, paired-sample t-test, and Fisher's exact test.
A total of 345 cases of open surgery alone and 52 cases of open surgery with adjunctive MMAE were identified. After control for subjective confounders, 146 patients treated with open surgery alone and 41 with adjunctive MMAE following open surgery with drain placement were included in the analysis. Before matching, the rebleeding risk and reintervention rate for open surgery trended higher in the open surgery alone than the open surgery plus MMAE group (14.4% vs 7.3%, p = 0.18; and 11.6% vs 4.9%, p = 0.17, respectively). No significant differences were seen in duration of radiographic or clinical follow-ups or decreases in hematoma size and mRS score at last follow-up. After one-to-one nearest neighbor propensity score matching, 26 pairs of cases were compared for outcomes. Rates of recurrence (7.7% vs 30.8%, p = 0.038) and overall reintervention (3.8% vs 23.1%, p = 0.049) after open surgery were found to be significantly lower in the adjunctive MMAE group than the open surgery-alone group. With one-to-many propensity score matching, 76 versus 37 cases were compared for open surgery alone versus adjunctive MMAE following open surgery. Similarly, the adjunctive MMAE group had significantly lower rates of recurrence (5.4% vs 19.7%, p = 0.037) and overall reintervention (2.7% vs 14.5%, p = 0.049).
Adjunctive MMAE following open surgery can lower the recurrence risks and reintervention rates for cSDH.
脑膜中动脉栓塞（MMAE）是一种新兴的血管内治疗技术，已被证明对慢性硬膜下血肿（cSDH）有良好的疗效。MMAE 作为开颅手术的辅助手段，旨在预防 cSDH 的复发。然而，MMAE 治疗 cSDH 术后复发的效果尚不清楚。作者旨在比较开颅术后行 MMAE 与单纯开颅手术的效果。
在作者所在机构，确定了仅行开颅手术（单纯开颅手术组）或 MMAE 联合开颅手术治疗 cSDH（辅助 MMAE 组）的患者。通过倾向评分匹配获得两组平衡。主要结局包括复发风险和再干预率。次要结局包括血肿大小和改良 Rankin 量表（mRS）评分的变化。采用 Mann-Whitney U 检验、配对样本 t 检验和 Fisher 确切概率法比较两组变量。
共纳入 345 例单纯开颅手术和 52 例 MMAE 联合开颅手术的病例。在控制主观混杂因素后，纳入 146 例单纯开颅手术和 41 例开颅术后留置引流管的辅助 MMAE 治疗的患者进行分析。匹配前，单纯开颅手术组的再出血风险和再干预率高于 MMAE 联合开颅手术组（14.4%比 7.3%，p=0.18；11.6%比 4.9%，p=0.17）。两组的影像学或临床随访时间、血肿体积减小率和末次随访时 mRS 评分无显著差异。经过一对一最近邻倾向评分匹配后，比较了 26 对病例的结果。与单纯开颅手术组相比，辅助 MMAE 组的复发率（7.7%比 30.8%，p=0.038）和总再干预率（3.8%比 23.1%，p=0.049）明显降低。采用一对多倾向评分匹配后，比较了 76 例单纯开颅手术和 37 例 MMAE 联合开颅手术后的情况。同样，辅助 MMAE 组的复发率（5.4%比 19.7%，p=0.037）和总再干预率（2.7%比 14.5%，p=0.049）明显较低。
开颅术后行 MMAE 可降低 cSDH 的复发风险和再干预率。
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