Liu Zhensheng, Wang Youwei, Tang Tieyu, Zhang Yunfeng, Sun Yong, Kuang XiongWei, Wei Tingfeng, Zhou Longjiang, Peng Aijun, Cao Demao, Hongsheng Wang, Qi Wentao, Chenyi Wu, Shan Qing
Department of Interventional Radiology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China.
Department of Neurosurgery, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China.
World Neurosurg. 2023 Nov;179:e6-e14. doi: 10.1016/j.wneu.2023.03.050. Epub 2023 Mar 15.
We sought to describe the resolution time of chronic subdural hematoma (CSDH) after middle meningeal artery embolization (MMAE) and potential variables that may affect hematoma resolution.
A retrospective analysis was performed on CSDH patients between December 2018 and December 2021. Patient characteristics, radiologic manifestations, and data of hematoma resolution were recorded. Univariate and multivariate analyses were conducted to identify predictors of CSDH resolution time.
A total of 53 patients were enrolled including 53 hematomas. Only 1 participant relapsed and did not require surgical evacuation. Hematoma resolution was observed in 27 (50.9%) at 4 months and 48 (90.6%) cases at the last radiologic follow-up. The median MMAE-to-resolution time was 19 weeks (interquartile range: 8-24). The burr-hole irrigation + MMAE group showed faster hematoma resolution than MMAE alone during early follow-up periods, but no significant difference was found at 6 months. Increased thickness of residual hematoma, excessive postoperative midline shift, high-density hematoma, mixed-density hematoma, separated hematoma, and anticoagulant or antiplatelet agents used were predictive of nonresolution at 4 months as determined by univariate analysis, whereas anticoagulant or antiplatelet agents used and high-density hematoma were not significant on multivariate analysis. No significant association was noted between hematoma resolution and comorbidities or other hematoma radiologic features.
MMAE is an effective and minimally invasive treatment for CSDH with a lower recurrence rate. The median resolution time of CSDH following MMAE was 19 weeks (interquartile range: 8-24). Burr-hole irrigation contributed to early hematoma resolution but had no significant effect at 6 months. In addition, residual hematoma thickness, postoperative midline shift, and specific type of hematoma were associated with delayed hematoma resolution at 4 months.
我们试图描述脑膜中动脉栓塞术（MMAE）后慢性硬膜下血肿（CSDH）的消退时间以及可能影响血肿消退的潜在变量。
对2018年12月至2021年12月期间的CSDH患者进行回顾性分析。记录患者特征、影像学表现和血肿消退数据。进行单因素和多因素分析以确定CSDH消退时间的预测因素。
共纳入53例患者，包括53个血肿。仅1例患者复发，无需手术清除血肿。4个月时27例（50.9%）观察到血肿消退，末次影像学随访时48例（90.6%）消退。MMAE至消退的中位时间为19周（四分位间距：8 - 24周）。在早期随访期间，钻孔冲洗 + MMAE组的血肿消退速度比单纯MMAE组快，但在6个月时未发现显著差异。单因素分析确定，残余血肿厚度增加、术后中线移位过多、高密度血肿、混合密度血肿、分隔血肿以及使用抗凝或抗血小板药物可预测4个月时血肿未消退，而多因素分析显示使用抗凝或抗血小板药物和高密度血肿无显著意义。未发现血肿消退与合并症或其他血肿影像学特征之间存在显著关联。
MMAE是治疗CSDH的一种有效且微创的方法，复发率较低。MMAE后CSDH的中位消退时间为19周（四分位间距：8 - 24周）。钻孔冲洗有助于早期血肿消退，但在6个月时无显著效果。此外，残余血肿厚度、术后中线移位和特定类型的血肿与4个月时血肿消退延迟有关。
