Dipartimento di Diagnostica per immagini, Radioterapia, Oncologia ed Ematologia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy.
Università Cattolica del Sacro Cuore, sede di Roma, Rome, Italy.
Acta Neurochir Suppl. 2023;135:115-118. doi: 10.1007/978-3-031-36084-8_19.
Chronic subdural hematoma (cSDH) is defined as a subdural collection of blood on CT imaging that tends to persist and gradually increase in volume over time, with components that are hypodense or isodense compared to the brain. There are no proven guidelines for the management of patients with cSDH. Surgical approaches included burr hole, twist drill hole, and craniotomy-based evacuations. Outcomes after surgical removal is generally favorable, but cSDH tends to recur after the initial evacuation.Middle meningeal artery (MMA) embolization has been gaining increasing popularity among the treatments of cSDH. This is largely due to a growing population of patients with cSDH who are refractory to other treatments or in patients who present with multiple comorbidities or who are taking antiplatelet and anticoagulant medications. The goal of middle meningeal artery (MMA) embolization is to devascularize subdural membranes associated with SDH so that the balance between continued leakage and reabsorption is shifted toward reabsorption.We discuss our clinical and technical approach to cSDH treated with perioperative embolization of the MMA.
慢性硬脑膜下血肿（cSDH）定义为 CT 成像上的硬脑膜下血液积聚，往往随着时间的推移持续存在并逐渐增加体积，与大脑相比，其成分呈低密或等密。目前尚无针对 cSDH 患者管理的既定指南。手术方法包括颅骨钻孔、颅骨钻孔和开颅清除术。手术切除后的结果通常是良好的，但 cSDH 在初次清除后往往会复发。脑膜中动脉（MMA）栓塞术在 cSDH 的治疗中越来越受到关注。这主要是由于越来越多的 cSDH 患者对其他治疗方法有抵抗力，或者是存在多种合并症的患者，或者是正在服用抗血小板和抗凝药物的患者。脑膜中动脉（MMA）栓塞的目的是使与 SDH 相关的硬脑膜血管化，以便将持续渗漏和再吸收之间的平衡转向再吸收。我们讨论了我们对接受 MMA 围手术期栓塞治疗的 cSDH 的临床和技术方法。
