Gal Zsombor T, See Alfred P
J Neurosurg Case Lessons. 2023 Oct 23;6(17). doi: 10.3171/CASE23436.
Chronic subdural hematoma (cSDH) in children is associated with several etiologies, one of which is nonaccidental trauma (NAT). Performed alone or as an adjunct to surgical intervention, middle meningeal artery (MMA) embolization may be effective in resolving and preventing the recurrence of cSDH in adult patients. However, MMA embolization for pediatric cSDH has not been adequately evaluated, and there exists no consensus on the appropriate selection of pediatric patients for this minimally invasive procedure. Appreciating the variable underlying pathophysiology of pediatric cSDH will enable the development of guidelines for patient selection.
A 14-month-old female patient presented with depressed consciousness, seizure-like activity, and apneic episodes. She was diagnosed with bilateral subacute on chronic SDH associated with NAT, and imaging revealed diffuse brain atrophy. Despite undergoing burr hole drainage, she developed refractory cSDH and was treated with bilateral MMA embolization. At her 10-month follow-up, magnetic resonance imaging revealed a decrease in the size of the subdural collections, and she was tolerating feeds, at her neurological baseline, and seizure-free.
Infants and young children with symptomatic cSDH secondary to NAT, whose tissue dynamics are reminiscent of cSDH in elderly patients with diffuse brain atrophy, may derive the most benefit from MMA embolization.
儿童慢性硬膜下血肿（cSDH）与多种病因相关，其中之一是非意外创伤（NAT）。单独进行或作为手术干预的辅助手段，脑膜中动脉（MMA）栓塞术可能对解决和预防成年患者的cSDH复发有效。然而，小儿cSDH的MMA栓塞术尚未得到充分评估，对于该微创手术小儿患者的合适选择也未达成共识。了解小儿cSDH潜在的病理生理学差异将有助于制定患者选择指南。
一名14个月大的女性患者出现意识减退、癫痫样活动和呼吸暂停发作。她被诊断为与NAT相关的双侧亚急性慢性硬膜下血肿，影像学显示弥漫性脑萎缩。尽管进行了钻孔引流，但她仍出现难治性cSDH，并接受了双侧MMA栓塞治疗。在10个月的随访中，磁共振成像显示硬膜下积液体积减小，她能耐受喂养，神经系统恢复至基线水平，且无癫痫发作。
因NAT继发有症状cSDH的婴幼儿，其组织动力学类似于患有弥漫性脑萎缩的老年患者的cSDH，可能从MMA栓塞术中获益最大。
