单节段脑膜中动脉栓塞术联合慢性硬膜下血肿清除术：多中心可行性、安全性和疗效评估

Single-Session Middle Meningeal Artery Embolization With Concomitant Evacuation Surgery for Chronic Subdural Hematomas: A Multicenter Assessment of Feasibility, Safety, and Efficacy.

作者信息

Gomez-Paz Santiago, Richter Kent, McGrath Maggie, Breton Jeffrey M, Wakelin Samuel H, Christie Immaculate, Pasko Kory B D, Aljuboori Ahmed, Hendrix Philipp, Weiner Gregory M, Slee Ben, Duckworth Edward A M, Burkhardt Jan-Karl, Srinivasan Visish M, Jankowitz Brian T, Snyder Thomas, Levitt Michael R, Armonda Rocco, Felbaum Daniel R, Ares William J, Salem Mohamed M, Grandhi Ramesh

机构信息

Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City , Utah , USA.

Department of Neurosurgery, Geisinger Wyoming Valley Medical Center, Wilkes-Barre , Pennsylvania , USA.

出版信息

Oper Neurosurg. 2025 Jul 3. doi: 10.1227/ons.0000000000001686.

DOI:10.1227/ons.0000000000001686

PMID:40607816

Abstract

BACKGROUND AND OBJECTIVES

Middle meningeal artery embolization (MMAE) is a safe and efficacious adjunct to surgical evacuation for symptomatic chronic subdural hematoma (cSDH). We evaluated the concomitant performance of MMAE with surgical evacuation in a single anesthetic session rather than a staged approach.

METHODS

In this retrospective, multicenter cohort study, patients with cSDH who underwent MMAE and surgical evacuation during 1 anesthetic session from January 2020 through August 2024 were included. The primary endpoints were feasibility (technical success), safety (complication and mortality rates), and efficacy (radiographic improvement and modified Rankin Scale score ≤2).

RESULTS

Among 157 patients (median age 74 years), 66% had unilateral cSDH and 34% had bilateral disease. Technical success was achieved in 153 patients (97.4%), with no major intraprocedural failures. The overall complication rate was 10.8%, including intraprocedural complications (ie, vessel injuries, cardiac arrest) in 4 patients (2.5%) and periprocedural adverse events in 13 patients (8.3%), including seizures, hemorrhages, respiratory failure, ischemic events, infections, and recurrent hematomas. The overall mortality rate was 12.7% (6 [3.8%] early postoperative deaths, 13 [8.3%] late unrelated deaths). Radiographic improvement was observed in 91.7% of patients, with 63.1% achieving ≥50% reduction in hematoma thickness at last available follow-up. At median follow-up of 54 days, 99/118 (83.9%) patients achieved or maintained functional independence (modified Rankin Scale ≤2).

CONCLUSION

Single-session MMAE with concomitant surgical evacuation proved feasible and safe. Radiographic and clinical outcomes were favorable, without higher complication rates compared with staged approaches. Future prospective studies should clarify the long-term benefits, assess the impact on resource use and cost-minimization, and determine ideal patient-selection criteria for this integrated treatment strategy.

摘要

背景与目的

对于有症状的慢性硬膜下血肿（cSDH），脑膜中动脉栓塞术（MMAE）是手术清除血肿的一种安全有效的辅助治疗方法。我们评估了在单次麻醉过程中而非分阶段进行MMAE与手术清除血肿的联合操作。

方法

在这项回顾性多中心队列研究中，纳入了2020年1月至2024年8月期间在单次麻醉过程中接受MMAE和手术清除血肿的cSDH患者。主要终点包括可行性（技术成功）、安全性（并发症和死亡率）以及有效性（影像学改善和改良Rankin量表评分≤2）。

结果

157例患者（中位年龄74岁）中，66%为单侧cSDH，34%为双侧病变。153例患者（97.4%）实现了技术成功，术中无重大失败情况。总体并发症发生率为10.8%，包括4例患者（2.5%）发生术中并发症（即血管损伤、心脏骤停）和13例患者（8.3%）发生围手术期不良事件，包括癫痫发作、出血、呼吸衰竭、缺血性事件、感染和复发性血肿。总体死亡率为12.7%（6例[3.8%]术后早期死亡，13例[8.3%]晚期非相关死亡）。91.7%的患者观察到影像学改善，在最后一次随访时，63.1%的患者血肿厚度减少≥50%。在中位随访54天时，118例患者中的99例（83.9%）实现或维持了功能独立（改良Rankin量表≤2）。