Golub Danielle, McBriar Joshua D, Donnelly Brianna M, Shao Miriam M, Virdi Tarika-Deep, Turpin Justin, White Timothy G, Ronnen Rebecca, Papadimitriou Kyriakos, Kutcher-Diaz Roberto, Dehdashti Amir R, Woo Henry H, Patsalides Athos, Link Thomas W
Department of Neurosurgery, Northwell Health, Manhasset, NY, USA.
Zucker School of Medicine at Hofstra University/Northwell Health, Hempstead, NY, USA.
Neuroradiology. 2024 Dec;66(12):2261-2273. doi: 10.1007/s00234-024-03490-0. Epub 2024 Oct 18.
Subdural hematoma (SDH) is quickly becoming the most common neurosurgical pathology due to the aging population. Middle meningeal artery embolization (MMAE) has recently emerged as an effective adjunct to surgical SDH evacuation by decreasing recurrence risk. MMAE has also shown promise as a standalone SDH intervention, but clinical and radiographic predictors of successful MMAE remain ill-defined.
Retrospective chart review from 2020 to 2023 at a single center identified all MMAE cases performed as primary SDH treatment. Cases were classified by hematoma internal architecture as homogeneous, separated, laminar, or trabecular. SDH maximal thickness was assessed on all follow-up imaging and any recurrences or expansions requiring surgery were denoted as treatment failures.
164 standalone MMAE cases were reviewed. Most cases were in male patients (75.0%) with a mean age of 73.2 years. The overall MMAE treatment failure rate was 6.7% with a 4.9% periprocedural complication rate. The cases with trabecular and laminar collections were slightly larger than those with homogeneous and separated collections (16.2 mm vs. 14.2 mm, p = 0.008*), but other baseline characteristics were similar. The MMAE failure rate was significantly lower in the laminar and trabecular subgroup (1.2%) compared to the homogeneous and separated subgroup (12.4%) (p = 0.005*). Homogeneous and separated internal hematoma architecture was the only predictor of MMAE failure in multivariate analysis (OR 10.5, p = 0.027*) and was also associated with delayed SDH resorption (ANOVA: F = 4.8, p = 0.0025*).
Standalone MMAE is an effective, safe, and durable treatment for non-acute SDHs, and is especially effective for SDHs with more membranous internal architecture.
由于人口老龄化，硬膜下血肿（SDH）正迅速成为最常见的神经外科病理疾病。脑膜中动脉栓塞术（MMAE）最近已成为一种有效的辅助手段，可通过降低复发风险来辅助外科手术清除SDH。MMAE作为一种独立的SDH干预手段也显示出前景，但成功的MMAE的临床和影像学预测因素仍不明确。
对2020年至2023年在单一中心进行的回顾性病历审查，确定了所有作为原发性SDH治疗进行的MMAE病例。病例根据血肿内部结构分为均匀型、分隔型、层状型或小梁型。在所有随访影像上评估SDH的最大厚度，任何需要手术的复发或扩大均被视为治疗失败。
回顾了164例独立的MMAE病例。大多数病例为男性患者（75.0%），平均年龄73.2岁。MMAE总体治疗失败率为6.7%，围手术期并发症发生率为4.9%。小梁型和层状型血肿的病例略大于均匀型和分隔型血肿的病例（16.2毫米对14.2毫米，p = 0.008*），但其他基线特征相似。与均匀型和分隔型亚组（12.4%）相比，层状型和小梁型亚组的MMAE失败率显著更低（1.2%）（p = 0.005*）。在多变量分析中，均匀型和分隔型内部血肿结构是MMAE失败的唯一预测因素（OR 10.5，p = 0.027*），并且还与SDH吸收延迟相关（方差分析：F = 4.8，p = 0.0025*）。
独立的MMAE是治疗非急性SDH的一种有效、安全且持久的方法，对具有更多膜性内部结构的SDH尤其有效。
