Falzon Andrew, Abdelghafar Ahmed, Hendriks Eef, Barazarte Hugo Andrade, Kostynskyy Alex, Boutet Alexandre, Itsekzon-Hayosh Ze'ev, Mosimann Pascal J
Division of Neuroradiology, University Medical Imaging and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada.
Department of Neurosurgery, Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada.
Interv Neuroradiol. 2025 Apr 29:15910199251328563. doi: 10.1177/15910199251328563.
Background and purposeDespite a rapidly growing body of literature supporting the treatment of chronic subdural hematoma (cSDH) with middle meningeal artery embolization (MMAE), real-life data is still scarce. This study aimed to evaluate MMAE radiological and clinical outcomes, based on radiological characteristics.Materials and MethodsFifty-two cSDH patients, treated by MMAE as a post-CSDH evacuation therapy in a single tertiary center, were included. Radiological outcome was evaluated with cSDH thickness/volume difference at routine follow-up compared to pre-MMAE CT head imaging. The cohort was divided into groups pertaining to cSDH laterality (bilateral and unilateral cSDH) and pre-MMAE hematoma thickness (>15 mm and ≤15 mm) for analysis. Patients who underwent evacuation MMAE were not included in the analysis to eliminate bias of surgical effect on hematoma progression.ResultsThirty patients had bilateral, and 22 patients had unilateral cSDH treated with bilateral and unilateral MMAE respectively. Twenty-nine patients had >15 mm pre-MMAE hematoma thickness, and 23 had ≤15 mm pre-MMAE hematoma thickness. Mean cSDH volume was lower at all follow-up intervals when compared to baseline and was reduced by a factor of 10 at the 3-6-month interval. The mean cSDH thickness was significantly lower at all three follow-up intervals when comparing each group (bilateral and unilateral MMAE) (pre-treatment hematoma thickness >15 mm and ≤15 mm). Larger hematomas with a thickness of >15 mm had a significantly greater reduction in mean cSDH volume interval follow-up than hematomas measuring ≤15 mm (1-3 months-63 mm, 40.6-85.69, < .001). Unilateral cSDH and MMAE demonstrated greater cSDH volume reduction compared to bilateral cSDH and MMAE at 1-3 months (42, 15.2-68.8, .001) and 3-6 months (33.7, 5.2-72.7, .043). No procedure-related major complications or deaths or recurrences were observed.ConclusionsAdjunctive MMAE after surgical evacuation appears safe and effective. MMAE is particularly effective for larger pre-treatment hematomas >15 mm (compared to ≤15 mm) and for unilateral cSDH and MMAE (compared to bilateral cSDH and MMAE).
尽管支持采用脑膜中动脉栓塞术（MMAE）治疗慢性硬膜下血肿（cSDH）的文献数量迅速增长，但实际应用数据仍然匮乏。本研究旨在根据影像学特征评估MMAE的影像学及临床疗效。
纳入52例在单一三级中心接受MMAE治疗的cSDH患者，MMAE作为cSDH清除术后的辅助治疗。通过对比MMAE术前头颅CT成像与常规随访时cSDH的厚度/体积差异评估影像学疗效。根据cSDH的部位（双侧和单侧cSDH）及MMAE术前血肿厚度（>15 mm和≤15 mm）对队列进行分组分析。为消除手术对血肿进展的影响，接受清除术联合MMAE治疗的患者未纳入分析。
30例患者为双侧cSDH，22例患者为单侧cSDH，分别接受双侧和单侧MMAE治疗。29例患者MMAE术前血肿厚度>15 mm，23例患者MMAE术前血肿厚度≤15 mm。与基线相比，所有随访时间点的cSDH平均体积均较低，在3 - 6个月时减少了10倍。在比较每组（双侧和单侧MMAE）（术前血肿厚度>15 mm和≤15 mm）时，所有三个随访时间点的cSDH平均厚度均显著降低。厚度>15 mm的较大血肿在随访期间的cSDH平均体积减少幅度明显大于测量值≤15 mm的血肿（1 - 3个月 - 63 mm，40.6 - 85.69，<0.001）。在1 - 3个月（42，15.2 - 68.8，0.001）和3 - 6个月（33.7，5.2 - 72.7，0.043）时，单侧cSDH和MMAE与双侧cSDH和MMAE相比，cSDH体积减少更大。未观察到与手术相关的严重并发症、死亡或复发。
手术清除术后辅助MMAE似乎安全有效。MMAE对术前较大血肿（>15 mm，与≤15 mm相比）以及单侧cSDH和MMAE（与双侧cSDH和MMAE相比）尤其有效。
