Khorasanizadeh MirHojjat, Shutran Max, Garcia Alfonso, Enriquez-Marulanda Alejandro, Moore Justin, Ogilvy Christopher S, Thomas Ajith J
1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and.
2Department of Neurological Surgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey.
J Neurosurg. 2022 Nov 11;138(6):1494-1502. doi: 10.3171/2022.9.JNS221663. Print 2023 Jun 1.
Middle meningeal artery (MMA) embolization (MMAE) is a new therapeutic modality for chronic subdural hematoma (cSDH). There is limited evidence comparing various MMAE procedural techniques, resulting in significant variations in technique and procedural planning. The objective of this study was to compare outcomes of MMAE by the number and location of MMA branches that were embolized.
A single-center retrospective study of patients with cSDH treated by MMAE was conducted. Clinical outcomes, need for re-intervention, and changes in hematoma size were compared between different MMAE techniques.
Ninety-four cSDHs in 78 patients were included. Embolization of the proximal trunk only, distal branches only, or proximal trunk plus distal branches resulted in similar rates of need for rescue surgery (7.4%, 13.0%, and 6.8%, respectively; p = 0.66) and rates of reducing the volume of the hematoma by at least 50% (74.1%, 80.0%, and 77.5%, respectively; p = 0.88). Embolization of only one branch had similar outcomes to embolization of more than one branch, as rescue surgery rates were 9.3% and 7.8% (p = 0.80), and rates ≥ 50% volume reduction were 75.6% and 78.3% (p = 0.76), respectively. Selective embolization of the dominant MMA branch was not associated with significantly different outcomes.
Outcomes of distal, proximal, or combined proximal and distal MMAE in cSDH are not significantly different. Embolization of more than one branch is not associated with improved treatment efficacy. Arguably, targeting any location in the MMA provides sufficient flow restriction to enable spontaneous hematoma resolution. Accordingly, a technical planning algorithm for cSDH MMAE is suggested.
脑膜中动脉（MMA）栓塞术（MMAE）是慢性硬膜下血肿（cSDH）的一种新治疗方式。比较各种MMAE手术技术的证据有限，导致技术和手术规划存在显著差异。本研究的目的是根据栓塞的MMA分支数量和位置比较MMAE的疗效。
对接受MMAE治疗的cSDH患者进行单中心回顾性研究。比较不同MMAE技术的临床疗效、再次干预的必要性以及血肿大小的变化。
纳入78例患者的94个cSDH。仅栓塞近端主干、仅栓塞远端分支或近端主干加远端分支导致的挽救性手术需求率相似（分别为7.4%、13.0%和6.8%；p = 0.66），血肿体积至少减少50%的比率相似（分别为74.1%、80.0%和77.5%；p = 0.88）。仅栓塞一个分支与栓塞多个分支的疗效相似，挽救性手术率分别为9.3%和7.8%（p = 0.80），血肿体积减少≥50%的比率分别为75.6%和78.3%（p = 0.76）。优势MMA分支的选择性栓塞与显著不同的疗效无关。
cSDH的远端、近端或近端与远端联合MMAE疗效无显著差异。栓塞多个分支与改善治疗效果无关。可以说，针对MMA的任何位置进行栓塞都能提供足够的血流限制，以使血肿自发消退。因此，提出了一种cSDH MMAE的技术规划算法。
