Onyx 与微球在慢性硬脑膜下血肿中治疗脑膜中动脉栓塞的对比。
Onyx Versus Particles for Middle Meningeal Artery Embolization in Chronic Subdural Hematoma.
机构信息
Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA.
Department of Neurosurgery, University of Texas Health Science Center, Houston, Texas, USA.
出版信息
Neurosurgery. 2023 May 1;92(5):979-985. doi: 10.1227/neu.0000000000002307. Epub 2022 Dec 30.
BACKGROUND
Middle meningeal artery (MMA) embolization has recently emerged as a treatment option for chronic subdural hematoma (cSDH). It is considered a simple and potentially safe endovascular procedure.
OBJECTIVE
To compare between 2 different embolic agents; onyx (ethylene vinyl alcohol) and emboparticles (polyvinyl alcohol particles-PVA) for endovascular treatment of cSDH.
METHODS
A retrospective analysis of all patients who underwent MMA embolization for cSDH treatment in 2 comprehensive centers between August 2018 and December 2021. Primary outcomes were failure of embolization and need for rescue surgical evacuation.
RESULTS
Among 97 MMA embolizations, 49 (50.5%) received onyx and 48 (49.5%) received PVA. The presence of acute or subacute on cSDH was higher in the PVA group 11/49 (22.5%) vs 30/48 (62.5%), respectively, P < .001. There were no significant differences between both groups regarding failure of embolization 6/49 (12.2%) vs 12/48 (25.0%), respectively, P = .112, and need of unplanned rescue surgical evacuation 5/49 (10.2%) vs 8/48 (16.7%), respectively, P = .354. Hematoma thickness at late follow-up was significantly smaller in the PVA group 7.8 mm vs 4.6 mm, respectively; P = .017.
CONCLUSION
Both onyx and PVA as embolic agents for cSDH can be used safely and have comparable clinical and surgical outcomes.
背景
中脑膜动脉（MMA）栓塞术最近已成为慢性硬脑膜下血肿（cSDH）的一种治疗选择。它被认为是一种简单且潜在安全的血管内手术。
目的
比较两种不同的栓塞剂：onyx（乙烯-乙烯醇）和 emboparticles（聚乙烯醇颗粒-PVA）在 cSDH 的血管内治疗中的效果。
方法
回顾性分析 2018 年 8 月至 2021 年 12 月在 2 个综合中心接受 MMA 栓塞治疗 cSDH 的所有患者。主要结局是栓塞失败和需要救援性手术清除血肿。
结果
在 97 例 MMA 栓塞术中，49 例（50.5%）使用 onyx，48 例（49.5%）使用 PVA。PVA 组 cSDH 中有急性或亚急性血肿的比例更高，分别为 11/49（22.5%）和 30/48（62.5%），P<.001。两组之间栓塞失败的发生率没有显著差异，分别为 6/49（12.2%）和 12/48（25.0%），P=.112，需要计划外的救援性手术清除血肿的发生率也没有显著差异，分别为 5/49（10.2%）和 8/48（16.7%），P=.354。PVA 组在晚期随访时的血肿厚度明显较小，分别为 7.8mm 和 4.6mm，P=.017。
结论
onyx 和 PVA 作为 cSDH 的栓塞剂都可以安全使用，且具有相似的临床和手术效果。
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