Meggyesy Michael, Xia Yuanxuan, Williams Gwendolyn, Lee Ryan, Kim Enoch, Biswas Dipankar, Xu Risheng, Gonzalez L Fernando, Luciano Mark
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan, USA.
World Neurosurg. 2025 Mar;195:123576. doi: 10.1016/j.wneu.2024.123576. Epub 2025 Jan 16.
Shunted hydrocephalus patients are at an inherent risk of developing chronic subdural hematomas (cSDHs) from overdrainage. The preliminary results of three much-anticipated clinical trials (STEM, EMBOLISE, MAGIC-MT) have recently been presented, showing efficacy of middle meningeal artery embolization (MMA-E) in reducing observational failure and the need for reoperation in non-shunted patients, but the effect of this procedure in shunted patients remains to be further investigated. In this series, we present our institution's experience with MMA-E in shunted normal pressure hydrocephalus patients in comparison to standard of care (=SOC).
We compared nine patients with normal pressure hydrocephalus, ventriculoperitoneal shunt, and shunt-induced cSDHs receiving SOC, shunt adjustment with or without burr hole drainage, to seven patients receiving SOC with MMA-E. Hematoma size and age of patients were matched. Patients were followed with serial head computed tomography scans. Symptoms, hematoma size, time to resolution, resolution status, and embolization details were monitored.
Six of seven SDH patients receiving MMA-E resolved. One patient showed residual but stable 3 mm cSDH after reinitiation of hydrocephalus treatment. The median time to resolution was 139.5 and 89 days for SOC without and with surgery, and 309 or 88 days for SOC without and with surgery plus MMA-E. One MMA-E patient was lost to follow-up and presented more than one year later with decreasing SDH that resolved by post-MMA-E day 504.
MMA-E in shunt-induced cSDHs has not shown increased resolution speed compared to SOC and liberal use of MMA-E on this cohort may need to be further investigated.
分流性脑积水患者因过度引流存在发生慢性硬膜下血肿（cSDH）的固有风险。最近公布了三项备受期待的临床试验（STEM、EMBOLISE、MAGIC-MT）的初步结果，显示脑膜中动脉栓塞术（MMA-E）在减少非分流患者的观察失败和再次手术需求方面具有疗效，但该手术在分流患者中的效果仍有待进一步研究。在本系列研究中，我们介绍了本机构在分流性正常压力脑积水患者中应用MMA-E的经验，并与标准治疗（=SOC）进行比较。
我们将9例患有正常压力脑积水、脑室腹腔分流术且因分流导致cSDH并接受SOC（即有或无钻孔引流的分流调整）的患者，与7例接受SOC联合MMA-E的患者进行比较。对患者的血肿大小和年龄进行匹配。通过连续的头部计算机断层扫描对患者进行随访。监测症状、血肿大小、消退时间、消退状态和栓塞细节。
接受MMA-E的7例SDH患者中有6例血肿消退。1例患者在重新开始脑积水治疗后出现残留但稳定的3mm cSDH。未进行手术和进行手术的SOC组血肿消退的中位时间分别为139.5天和89天，未进行手术和进行手术加MMA-E的SOC组分别为309天或88天。1例接受MMA-E的患者失访，一年多后出现SDH缩小，并在MMA-E术后第504天消退。
与SOC相比，MMA-E治疗分流性cSDH并未显示出更快的消退速度，对此类患者广泛使用MMA-E可能需要进一步研究。
