Vazquez Sima, Zuckerman David A, Gandhi Chirag, Al-Mufti Fawaz, Muh Carrie, Santarelli Justin, Pisapia Jared M
School of Medicine, New York Medical College, Valhalla, New York, USA.
Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA.
Pediatr Neurosurg. 2024;59(1):44-53. doi: 10.1159/000534895. Epub 2023 Oct 30.
Middle meningeal artery (MMA) embolization has been increasingly applied in adult populations for the treatment of chronic subdural hematomas (cSDH). There is a paucity of literature on the indications, safety, and outcomes of MMA embolization in the pediatric population.
A systematic literature review on pediatric patients undergoing MMA embolization was performed. We also report the case of successful bilateral MMA embolization for persistent subdural hematomas following resection of a juvenile pilocytic astrocytoma. Persistent bilateral subdural hematomas following resection of a large brain tumor resolved following MMA embolization in a 13-year-old male. Indications for MMA embolization in the pediatric literature included cSDH (6/13, 46.2%), treatment or preoperative embolization of arteriovenous fistula or arteriovenous malformation (3/13, 23.1%), preoperative embolization for tumor resection (1/13, 7.7%), or treatment of acute epidural hematoma (1/13, 7.7%). Embolic agents included microspheres or microparticles (2/13, 15.4%), Onyx (3/13, 23.1%), NBCA (3/13, 23.1%), or coils (4/13, 30.8%).
Whereas MMA embolization has primarily been applied in the adult population for subdural hematoma in the setting of cardiac disease and anticoagulant use, we present a novel application of MMA embolization in the management of persistent subdural hematoma following resection of a large space-occupying lesion. A systematic review of MMA embolization in pediatric patients currently shows efficacy; a multi-institutional study is warranted to further refine indications, timing, and safety of the procedure.
脑膜中动脉（MMA）栓塞术在成人慢性硬膜下血肿（cSDH）治疗中的应用日益广泛。关于小儿人群MMA栓塞术的适应证、安全性和疗效的文献较少。
对接受MMA栓塞术的小儿患者进行了系统的文献综述。我们还报告了1例成功进行双侧MMA栓塞术治疗青少年毛细胞型星形细胞瘤切除术后持续性硬膜下血肿的病例。1例13岁男性在切除大的脑肿瘤后出现持续性双侧硬膜下血肿，经MMA栓塞术后血肿消失。小儿文献中MMA栓塞术的适应证包括cSDH（6/13，46.2%）、动静脉瘘或动静脉畸形的治疗或术前栓塞（3/13，23.1%）、肿瘤切除术前栓塞（1/13，7.7%）或急性硬膜外血肿的治疗（1/13，7.7%）。栓塞剂包括微球或微粒（2/13，15.4%）、Onyx（3/13，23.1%）、NBCA（3/13，23.1%）或弹簧圈（4/13，30.8%）。
虽然MMA栓塞术主要在成人中应用于心脏病和使用抗凝剂情况下的硬膜下血肿，但我们展示了MMA栓塞术在治疗大型占位性病变切除术后持续性硬膜下血肿中的新应用。目前对小儿患者MMA栓塞术的系统评价显示了其有效性；有必要开展多机构研究以进一步明确该手术的适应证、时机和安全性。
