Palmer Brandi, Campbell Melody, Maertz Kellie, Narigon Laurie, Herzing Karen, Santry Heena, Boyce William, Narayanan Ragavan, Patel Akil
Department of Trauma and Acute Care Surgery, Kettering Health Main Campus, Kettering, Ohio, United States.
Department of Radiology, Kettering Health Main Campus, Kettering, Ohio, United States.
Surg Neurol Int. 2024 Mar 1;15:71. doi: 10.25259/SNI_607_2023. eCollection 2024.
Chronic subdural hematoma (cSDH) is a common sequela of traumatic brain injury. Middle meningeal artery embolization (MMAE) has shown promising results as an emerging minimally invasive alternative treatment. The purpose of this study is to examine the safety and efficacy of MMAE performed in patients with cSDH, acute-on-chronic, and subacute SDH with a traumatic etiology.
This retrospective study included cases performed at a Level II Trauma Center between January 2019 and December 2020 for MMAE of cSDHs. Data collected included patient demographic characteristics and comorbidities, SDH characteristics, complications, and efficacy outcomes. The lesion measurements were collected before the procedure, 4-6 weeks and 3-6 months post-procedure.
In our patient population, 78% (39) either had lesions improve or completely resolved. The sample included 50 patients with a mean age of 74 years old. Statistically significant reductions in lesion size were found from pre- to post-procedure in the left lesions, right lesions, and midline shifts. The left lesions decreased from 13.88 ± 5.70 mm to 3.19 ± 4.89 mm at 3-6 months with < 0.001. The right lesions decreased from 13.74 ± 5.28 mm to 4.93 ± 7.46 mm at 3-6 months with = 0.02. Midline shifts decreased from 3.78 ± 3.98 mm to 0.48 ± 1.31 mm at 3-6 months with = 0.02. No complications were experienced for bleeding, hematoma, worsening SDH, pseudoaneurysm, or stroke.
Our pilot study from a single center utilizing MMAE demonstrates that MMAE is successful without increasing treatment-related complications not only for cSDH but also in acute-on-cSDH and SDH with a subacute component.
慢性硬膜下血肿（cSDH）是创伤性脑损伤的常见后遗症。脑膜中动脉栓塞术（MMAE）作为一种新兴的微创替代治疗方法已显示出有前景的结果。本研究的目的是检验对患有cSDH、慢性硬膜下血肿急性发作和具有创伤病因的亚急性硬膜下血肿患者进行MMAE的安全性和有效性。
这项回顾性研究纳入了2019年1月至2020年12月在一家二级创伤中心进行的cSDH的MMAE病例。收集的数据包括患者人口统计学特征和合并症、硬膜下血肿特征、并发症及疗效结果。在术前、术后4 - 6周和3 - 6个月收集病变测量数据。
在我们的患者群体中，78%（39例）的病变得到改善或完全消退。样本包括50例患者，平均年龄74岁。术前到术后，左侧病变、右侧病变和中线移位的病变大小在统计学上有显著减小。左侧病变在3 - 6个月时从13.88±5.70毫米降至3.19±4.89毫米，P<0.001。右侧病变在3 - 6个月时从13.74±5.28毫米降至4.93±7.46毫米，P = 0.02。中线移位在3 - 6个月时从3.78±3.98毫米降至0.48±1.31毫米，P = 0.02。未发生出血、血肿、硬膜下血肿恶化、假性动脉瘤或中风等并发症。
我们来自单一中心利用MMAE的初步研究表明，MMAE不仅对cSDH成功，而且对慢性硬膜下血肿急性发作和具有亚急性成分的硬膜下血肿也成功，且不会增加与治疗相关的并发症。
