Diana Francesco, Romoli Michele, Ricchetti Francesca, Milonia Luca, Salcuni Andrea, Cirelli Carlo, Ruzza Alberto Di, Gaudino Chiara, Iacobucci Marta, Biraschi Francesco
Interventional Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain.
Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain.
Interv Neuroradiol. 2023 Aug 30:15910199231198909. doi: 10.1177/15910199231198909.
Middle meningeal artery embolization (MMAE) for the management of chronic subdural hematomas (CSDH) with ethylene vinyl alcohol (EVOH) causes an evident patient discomfort due to meningeal nociceptors stimulation. The aim of this study was to assess safety and efficacy of intra-arterial lidocaine (IAL) before MMAE of CSDH with EVOH.
We analyzed all consecutive patients with bilateral CSDH undergoing MMAE with EVOH. We used a monolateral IAL injection, with casual allocation. We assessed the headache felt by patients during embolization with the visual analog scale (VAS) and compared scores obtained after embolization of both sides. We followed the STROBE guidelines for case-control studies. Paired t-test and χ test were used to compare the distribution of variables in IAL vs control group.
Between September 2021 and March 2023, 32 patients underwent bilateral MMAE with EVOH for a CSDH. Lidocaine treatment resulted in a substantially lower VAS score compared to the control group (median 3 vs 7, p < 0.001), with no substantial side effect. Compliance also benefited from lidocaine administration.
In patients with CSDH undergoing MMAE, IAL seems to reduce pain sensation associated with EVOH injection and to increase patients' compliance during treatment.
使用乙烯醇共聚物（EVOH）进行慢性硬膜下血肿（CSDH）的脑膜中动脉栓塞术（MMAE）时，由于刺激脑膜伤害感受器，会给患者带来明显不适。本研究旨在评估在使用EVOH进行CSDH的MMAE之前动脉内注射利多卡因（IAL）的安全性和有效性。
我们分析了所有连续接受EVOH-MMAE治疗双侧CSDH的患者。我们采用单侧IAL注射，随机分配。我们使用视觉模拟量表（VAS）评估患者在栓塞过程中感受到的头痛，并比较两侧栓塞后获得的分数。我们遵循STROBE病例对照研究指南。采用配对t检验和χ检验比较IAL组与对照组变量的分布。
在2021年9月至2023年3月期间，32例患者接受了EVOH-MMAE治疗CSDH。与对照组相比，利多卡因治疗使VAS评分显著降低（中位数3 vs 7，p < 0.001），且无明显副作用。利多卡因给药也提高了患者的依从性。
在接受MMAE治疗的CSDH患者中，IAL似乎可以减轻与EVOH注射相关的疼痛感，并提高患者在治疗期间的依从性。
