Granstein Justin H, Fodor Thomas B, Young Michael, Muram Sandeep, Salih Mira, Garcia Roberto, Kan Peter, Taussky Philipp, Ogilvy Christopher S
Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St Suite 3B, Boston, MA 02215, USA; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA.
Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St Suite 3B, Boston, MA 02215, USA.
Clin Neurol Neurosurg. 2025 Feb;249:108747. doi: 10.1016/j.clineuro.2025.108747. Epub 2025 Jan 17.
The estimated incidence of chronic subdural hematomas (cSDH) in the general population is projected to nearly double over the next decade, likely making it the most commonly treated cranial neurosurgical condition in adults by 2030. We investigated the outcomes of middle meningeal artery embolization (MMAe) as either a primary or adjunctive treatment for cSDH in nonagenarian patients.
We retrospectively reviewed all patients 90 years of age or older treated with middle meningeal artery embolization for cSDH from 2018 to 2024 at two academic institutions. Statistical analysis was performed on patient demographics, baseline functional status, intervention, cSDH size, recurrence rate, reintervention rate, and follow-up functional status.
Twenty-one patients aged 90 or older were identified who were treated with MMAe for cSDH. Hematoma thickness ranged from 10mm to 34mm with a mean midline shift of 4.6mm. Eighteen patients were treated with MMAe alone, while three patients underwent surgery followed by MMAe. A total of 20 patients had radiological follow up, with no evidence of growth or recurrence in 95 % of the patients. There was one recurrent cSDH in our cohort in the setting of new trauma after hospital discharge. There was one complication related to the MMAe procedure which was a femoral artery pseudoaneurysm that resolved without further treatment. Median baseline mRS was 3 prior to MMAe and median follow-up mRS after treatment was 2.
MMAe is a safe and efficacious treatment for nonagenarian patients with cSDH, and shows promise as a potential primary treatment modality.
预计在未来十年，普通人群中慢性硬膜下血肿（cSDH）的发病率将几乎翻倍，到2030年可能使其成为成人中最常见的接受治疗的颅脑神经外科疾病。我们研究了脑膜中动脉栓塞术（MMAe）作为老年患者cSDH的主要或辅助治疗方法的疗效。
我们回顾性分析了2018年至2024年在两家学术机构接受脑膜中动脉栓塞术治疗cSDH的所有90岁及以上患者。对患者的人口统计学、基线功能状态、干预措施、cSDH大小、复发率、再次干预率和随访功能状态进行了统计分析。
确定了21例90岁及以上接受MMAe治疗cSDH的患者。血肿厚度为10mm至34mm，平均中线移位4.6mm。18例患者仅接受了MMAe治疗，3例患者先接受手术，然后接受MMAe治疗。共有20例患者进行了影像学随访，95%的患者没有生长或复发的迹象。在我们的队列中，有1例cSDH在出院后因新的创伤而复发。有1例与MMAe手术相关的并发症，即股动脉假性动脉瘤，未经进一步治疗即自行消退。MMAe术前中位mRS为3，治疗后随访中位mRS为2。
MMAe是治疗老年cSDH患者的一种安全有效的方法，有望成为一种潜在的主要治疗方式。
