García García Sergio, Arrese Regañón Ignacio, Cepeda Chafla Santiago, Sarabia Herrero Rosario
Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Hospital Universitario Rio Hortega, Valladolid, Spain.
Department of Neurosurgery, Hospital Universitario Rio Hortega, Valladolid, Spain.
Neurocirugia (Engl Ed). 2025 Jan-Feb;36(1):28-38. doi: 10.1016/j.neucie.2024.09.002. Epub 2024 Sep 17.
Chronic subdural hematoma (cSDH) is a prevalent neurosurgical condition with an increasing incidence due to the rising life expectancy and the widespread use of anticoagulant and antiplatelet therapies. Insights into the inflammatory origins of cSDH led to the exploration of Middle Meningeal Artery (MMA) embolization as a therapeutic strategy. In recent years the endovascular treatment of MMA has gained momentum. Herein we present the initial experience of a dual trained neurovascular unit implementing this therapeutic technique.
This single-center, prospective pilot study aimed to evaluate the feasibility, safety, and efficacy of MMA embolization in the treatment of cSDH. Following ethical approval and informed consent, demographic, clinical, and radiological data were collected. Patients requiring emergent surgical treatment were excluded. The study focused on assessing clinical outcomes, including the Modified Rankin Score (mRS) and volumetric analysis of cSDH, before and after embolization.
Fifteen patients underwent MMA embolization, with a predominance of males (80%) and a mean age of 72.4 years. The most common presenting symptom was headache (53.3%). The average hospital stay was 3.9 days. Various embolization techniques were employed, with DMSO-EVOH being the most frequent. All procedures were successfully conducted without complications. Although not statistically significant, trends suggested better outcomes in patients with homogeneous cSDH on the CT scan, displaying the cotton wool sign on angiography and treated with EVOH-DMSO.
MMA embolization for cSDH demonstrates promise as a safe and effective treatment, potentially reducing the need for surgical intervention and recurrence rates. This study lays the groundwork for a larger, randomized controlled trial which protocol is herein presented.
慢性硬膜下血肿（cSDH）是一种常见的神经外科疾病，随着预期寿命的延长以及抗凝和抗血小板治疗的广泛应用，其发病率呈上升趋势。对cSDH炎症起源的深入了解促使人们探索将脑膜中动脉（MMA）栓塞作为一种治疗策略。近年来，MMA的血管内治疗得到了快速发展。在此，我们介绍一个同时具备神经血管双专业能力的科室实施这种治疗技术的初步经验。
这项单中心前瞻性试点研究旨在评估MMA栓塞治疗cSDH的可行性、安全性和有效性。在获得伦理批准并取得知情同意后，收集了人口统计学、临床和放射学数据。排除需要紧急手术治疗的患者。该研究重点评估栓塞前后的临床结局，包括改良Rankin量表（mRS）评分以及cSDH的体积分析。
15例患者接受了MMA栓塞治疗，其中男性占多数（80%），平均年龄为72.4岁。最常见的症状是头痛（53.3%）。平均住院时间为3.9天。采用了多种栓塞技术，其中二甲基亚砜-乙烯醇共聚物（DMSO-EVOH）最为常用。所有手术均成功完成，无并发症发生。尽管无统计学意义，但趋势表明，CT扫描显示为均匀性cSDH、血管造影显示有棉絮征且接受EVOH-DMSO治疗的患者预后较好。
MMA栓塞治疗cSDH显示出有望成为一种安全有效的治疗方法，可能减少手术干预的需求和复发率。本研究为一项更大规模的随机对照试验奠定了基础，本文还介绍了该试验方案。
