Gomez-Paz Santiago, Andreão Filipi Fim, Kendall Nicholas, Richter Kent R, McGrath Margaret, Breton Jeffrey M, Aljuboori Ahmed, Hendrix Philipp, Weiner Gregory M, Duckworth Edward A M, McNulty Alana M, Burkhardt Jan-Karl, Srinivasan Visish M, Snyder Thomas, Jankowitz Brian T, Levitt Michael R, Armonda Rocco A, Felbaum Daniel R, Paul Alexandra R, Salem Mohamed M, Grandhi Ramesh
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Oper Neurosurg. 2025 Aug 11. doi: 10.1227/ons.0000000000001747.
Single-session middle meningeal artery embolization (MMAE) combined with surgical evacuation is a rapidly emerging strategy in the treatment of chronic subdural hematoma (cSDH). However, the effect of different evacuation techniques within this approach remains unclear.
We conducted a retrospective multicenter cohort study across 8 US institutions of patients with cSDH who underwent single-session MMAE with concomitant surgical evacuation between 2018 and 2024. Surgical techniques were categorized as craniotomy or burr-hole evacuation (twist drill, electric drill, or subdural evacuating port systems). Primary outcomes included procedural time, adverse events, and early clinical outcomes.
The 205 included patients (30.2% female) underwent 276 procedures (35 craniotomies, 241 burr-hole evacuations). The median patient age was 75 years, and 157 (76.6%) patients were functionally independent at baseline. Subdural characteristics were similar in the craniotomy (n = 26) and the burr-hole evacuation (n = 179) groups. Patients who underwent craniotomy had longer drainage durations (P < .001) and longer operative times (209 vs 190 min, P = .015). Patients undergoing craniotomy were also less likely to be discharged by postoperative day 6 (P = .040). Procedural mortality rates were low overall (0.4%) and did not differ significantly between groups. Early postoperative mortality rates (3.3% overall) were also comparable across both groups. Overall mortality was higher in craniotomy patients (34.3% vs 10.4%, adjusted odds ratio = 3.69; 95% confidence interval: 1.23-11.06; P = .019), mainly because of late mortality and not attributable to the index procedure.
In this multicenter study of single-session MMAE with concomitant evacuation for cSDH, burr-hole-based techniques were associated with shorter operative times and with postprocedural patterns such as earlier drain removal, which correlated with earlier discharge. These findings support the preferential use of minimally invasive evacuation methods within the single-session paradigm when anatomically and technically appropriate.
单次脑膜中动脉栓塞术（MMAE）联合手术引流是治疗慢性硬膜下血肿（cSDH）的一种迅速兴起的策略。然而，该方法中不同引流技术的效果仍不明确。
我们在美国8家机构进行了一项回顾性多中心队列研究，研究对象为2018年至2024年间接受单次MMAE并同时进行手术引流的cSDH患者。手术技术分为开颅手术或钻孔引流（麻花钻、电钻或硬膜下引流端口系统）。主要结局包括手术时间、不良事件和早期临床结局。
纳入的205例患者（女性占30.2%）共接受了276次手术（35例开颅手术，241例钻孔引流）。患者的中位年龄为75岁，157例（76.6%）患者在基线时功能独立。开颅手术组（n = 26）和钻孔引流组（n = 179）的硬膜下特征相似。接受开颅手术的患者引流时间更长（P <.001），手术时间也更长（209分钟对190分钟，P =.015）。接受开颅手术的患者在术后第6天出院的可能性也较小（P =.040）。总体手术死亡率较低（0.4%），两组之间无显著差异。两组术后早期死亡率（总体为3.3%）也相当。开颅手术患者的总体死亡率较高（34.3%对10.4%，调整后的优势比 = 3.69；95%置信区间：1.23 - 11.06；P =.019），主要是由于晚期死亡率，而非归因于索引手术。
在这项关于单次MMAE联合cSDH引流的多中心研究中，基于钻孔的技术与较短的手术时间以及术后诸如更早拔除引流管等模式相关，这与更早出院相关。这些发现支持在解剖和技术合适的情况下，在单次治疗模式中优先使用微创引流方法。
