1Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.
2College of Medicine, Medical University of South Carolina, Charleston, South Carolina.
J Neurosurg. 2022 Nov 11;139(1):131-138. doi: 10.3171/2022.10.JNS221476. Print 2023 Jul 1.
Middle meningeal artery (MMA) embolization and the Subdural Evacuation Port System (SEPS) are minimally invasive treatment paradigms for chronic subdural hematoma (cSDH). Although SEPS offers acute decompression of local mass effect from a cSDH, MMA embolization has been shown to reduce the rate of cSDH recurrence. In combination, these procedures present a potentially safer strategy to a challenging pathology. The authors present a multi-institutional retrospective case series that assessed the safety, efficacy, and complications of SEPS and MMA embolization for cSDH.
A retrospective review was performed of patients who underwent SEPS placement and MMA embolization for cSDH between 2018 and 2021 at three institutions.
One hundred patients with 136 cSDHs and a median age of 73 years underwent both SEPS placement and MMA embolization. Initial Glasgow Coma Scale scores were between 14 and 15 in 81% of patients and between 9 and 13 in 14%. The median initial midline shift (MLS) was 7 mm, with subdural hematoma (SDH) in the left hemisphere (lh) in 30% of patients, right hemisphere (rh) in 34%, and bilateral hemispheres in 36%. Follow-up was available for 86 patients: 93.4% demonstrated decreased MLS, and all patients with lhSDH and rhSDH demonstrated progressive decrease in SDH size. The overall complication rate was 4%, including 1 case of facial palsy and 3 cases of iatrogenic acute SDH. Two subjects (2%) required craniotomy for hematoma evacuation. The rate of good functional outcomes, with modified Rankin Scale (mRS) score < 2, was 89% on final follow-up and the overall mortality rate was 2%. A good mRS score on admission was associated with increased odds of functional improvement at follow-up (p < 0.001).
SEPS placement with MMA embolization for cSDH can be done safely and effectively reduces cSDH size with minimal perioperative morbidity.
中脑膜动脉（MMA）栓塞和硬脑膜下引流端口系统（SEPS）是慢性硬脑膜下血肿（cSDH）的微创治疗方案。尽管 SEPS 可提供 cSDH 局部占位效应的急性减压，但 MMA 栓塞已被证明可降低 cSDH 复发率。结合这两种方法，为具有挑战性的病理提供了一种潜在更安全的策略。作者提出了一项多机构回顾性病例系列研究，评估了 SEPS 和 MMA 栓塞治疗 cSDH 的安全性、疗效和并发症。
对 2018 年至 2021 年在三个机构接受 SEPS 放置和 MMA 栓塞治疗 cSDH 的患者进行回顾性分析。
100 例 136 例 cSDH 患者，中位年龄为 73 岁，均接受 SEPS 放置和 MMA 栓塞治疗。81%的患者初始格拉斯哥昏迷量表（GCS）评分为 14-15 分，14%的患者评分为 9-13 分。初始中线移位（MLS）中位数为 7mm，30%的患者左侧半球（lh）有硬膜下血肿（SDH），34%的患者右侧半球（rh）有 SDH，36%的患者双侧半球均有 SDH。86 例患者可获得随访：93.4%的患者 MLS 降低，所有 lhSDH 和 rhSDH 患者的 SDH 大小均逐渐减小。总体并发症发生率为 4%，包括 1 例面瘫和 3 例医源性急性 SDH。2 例（2%）患者因血肿清除而行开颅手术。最终随访时，功能良好结局（改良 Rankin 量表[mRS]评分<2）的比例为 89%，总死亡率为 2%。入院时 mRS 评分较好与随访时功能改善的可能性增加相关（p<0.001）。
SEPS 联合 MMA 栓塞治疗 cSDH 安全有效，可减少 cSDH 体积，围手术期发病率低。
