硬膜下引流端口系统（SEPS）和脑膜中动脉栓塞术（MMAE）治疗慢性硬膜下血肿的有效性——一项多中心经验
Effectiveness of subdural evacuating port system (SEPS) and middle meningeal artery embolization (MMAE) for chronic subdural hematomas - a multicenter experience.
作者信息
Lim Jaims, Jaikumar Vinay, Paul Alexandra R, Cullen Matthew, Kellner Christopher P, Mocco J, Philbrick Brandon D, Vakharia Kunal, Wahlig Patrick, Kruk Marissa D, Snyder Kenneth V, Levy Elad I, Davies Jason M, Siddiqui Adnan H
机构信息
Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA.
出版信息
J Neurointerv Surg. 2025 Jun 19. doi: 10.1136/jnis-2025-023489.
BACKGROUND
Craniotomy for subdural hematoma (SDH) in elderly patients with comorbidities can be challenging. The Subdural Evacuating Port System (SEPS; Medtronic, Minneapolis, MN) offers a less invasive alternative, while middle meningeal artery embolization (MMAE) has shown effectiveness in preventing SDH recurrence. We evaluated the combined effectiveness of SEPS+MMAE for chronic SDH (cSDH) treatment.
METHODS
Retrospective database reviews were conducted. Demographic, comorbidity, procedural, and outcomes data were analyzed. cSDH resolution was tracked by measuring hematoma volumes on noncontrast computed tomograms pre-SEPS+MMAE, 24-48 hours post-SEPS+MMAE, and 6-8 weeks afterward (follow-up-SEPS+MMAE).
RESULTS
Our study included 114 patients (median age: 77 years (interquartile range (IQR): 69-83 years); men: women=74:40) with 134 cSDHs treated with SEPS+MMAE were included. Median pre-SEPS+MMAE cSDH volume was 122.9 mL (88-152.4 mL) with midline shift of 6 mm (3.4-9.5 mm). Most MMAE procedures were performed under general anesthesia (68.7%), utilizing the femoral approach (61.9%) and particle embolic agents (55.2%). In-hospital rescue craniotomy was required after 10 (7.5%) procedures. Median post-SEPS+MMAE and follow-up-SEPS+MMAE cSDH volume reductions were 71.1 mL (54.1-94.8 mL) and 23.4 mL (2-56.3 mL), respectively, resulting in 38.1% (22.1-52.9%) and 79.9% (51-97.8%) reductions, respectively. Of 109 patients with follow-up, 10 (9.2%) were readmitted for cSDH residual/recurrence within 90 days, eight (7.3%) required retreatment: five (4.6%) with craniotomy, three (2.8%) with SEPS. Hyperlipidemia (P=0.002), anticoagulant use (P=0.036), and larger pre-SEPS+MMAE cSDH volume (P<0.001) predicted greater SEPS-mediated clearance. Older age (P=0.03), coronary artery disease (P=0.004), membranes within cSDH (P=0.039), acute/subacute components in cSDH (P=0.047), and unilateral cSDH (P=0.017) predicted less SEPS-mediated clearance. Older age (P=0.006), acute/subacute components in cSDH (P=0.016), and longer follow-up (P=0.013) predicted higher MMAE effectiveness. Higher pre-SEPS+MMAE cSDH volume (P=0.047) and unilateral MMAE for bilateral cSDH (P=0.036) predicted lower MMAE effectiveness.
CONCLUSION
SEPS+MMAE was an effective, safe treatment for cSDH.
背景
对于患有合并症的老年患者，进行开颅手术治疗硬膜下血肿（SDH）具有挑战性。硬膜下引流端口系统（SEPS；美敦力公司，明尼阿波利斯，明尼苏达州）提供了一种侵入性较小的替代方法，而脑膜中动脉栓塞术（MMAE）已显示出在预防SDH复发方面的有效性。我们评估了SEPS+MMAE联合治疗慢性硬膜下血肿（cSDH）的有效性。
方法
进行回顾性数据库审查。分析人口统计学、合并症、手术和结果数据。通过在SEPS+MMAE术前、SEPS+MMAE术后24 - 48小时以及之后6 - 8周（SEPS+MMAE随访）测量非增强计算机断层扫描上的血肿体积来追踪cSDH的消退情况。
结果
我们的研究纳入了114例患者（中位年龄：77岁（四分位间距（IQR）：69 - 83岁）；男性：女性 = 74:40），共134例接受SEPS+MMAE治疗的cSDH。SEPS+MMAE术前cSDH的中位体积为122.9 mL（88 - 152.4 mL），中线移位6 mm（3.4 - 9.5 mm）。大多数MMAE手术在全身麻醉下进行（68.7%），采用股动脉入路（61.9%）和颗粒栓塞剂（55.2%）。10例（7.5%）手术后需要进行院内抢救性开颅手术。SEPS+MMAE术后和SEPS+MMAE随访时cSDH体积的中位减少量分别为7·1 mL（54.1 - 94.8 mL）和23.4 mL（2 - 56.3 mL），分别导致减少38.1%（22.1 - 52.9%）和79.9%（51 - 97.8%）。在109例有随访的患者中，10例（9.2%）在90天内因cSDH残留/复发再次入院，8例（7.3%）需要再次治疗：5例（4.6%）接受开颅手术，3例（2.8%）接受SEPS治疗。高脂血症（P = 0.002）、使用抗凝剂（P = 0.036）和SEPS+MMAE术前较大的cSDH体积（P < 0.001）预示着SEPS介导的清除效果更好。年龄较大（P = 0.03）、冠状动脉疾病（P = 0.004）、cSDH内有隔膜（P = 0.039）、cSDH中有急性/亚急性成分（P = 0.047）以及单侧cSDH（P = 0.017）预示着SEPS介导的清除效果较差。年龄较大（P = 0.006）、cSDH中有急性/亚急性成分（P = 0.016）以及随访时间较长（P = 0.013）预示着MMAE效果较高。SEPS+MMAE术前较高的cSDH体积（P = 0.047）和双侧cSDH采用单侧MMAE（P = 0.036）预示着MMAE效果较低。
结论
SEPS+MMAE是治疗cSDH的一种有效、安全的方法。
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