脑膜中动脉栓塞术治疗慢性硬膜下血肿——一项关于718例栓塞术的德国全国多中心研究
Middle Meningeal Artery Embolization for the Treatment of Chronic Subdural Hematomas-a German Nationwide Multi-center Study On 718 Embolizations.
作者信息
Vollherbst Dominik F, Berlis Ansgar, Zaki Mahmoud, Maurer Christoph, Onyinzo Christina, Keil Fee C, Mann Leonard, Arendt Christophe T, Hartmann Marius, Reißberg Steffen, Rutschke Corinna, Kallenberg Kai, Grau Stefan, Durutya Alexandru, Liebert Adrian, Voit-Höhne Heinz L, Holtmannspötter Markus, Herweh Christian, Chapot René, Elsharkawy Mohamed, Meila Dan, Greling Björn, Boxberg Frederik, Grieb Dominik, Deuschl Cornelius, Ahmadipour Yahya, Boeckh-Behrens Tobias, Bodden Jannis, Lukas Carsten, Kämmerer Felix, Behme Daniel, Diamandis Elie, Siebert Eberhard, Meddeb Aymen, Kreiser Kornelia, Heinz Sabine, Meckel Stephan, Berzeg-Kolck Semin, Fiehler Jens, Bechstein Matthias, Kaschner Marius G, Darvishi Keihan, Leukert Laura S, Brockmann Marc A, Mayer Thomas E, Buhk Jan-Hendrik, Weyland Charlotte S, Görtz Lukas, Kabbasch Christoph, Weber Werner, Wendl Christina, Struffert Tobias, Dyzmann Christian, Gerber Johannes C, Bendszus Martin, Möhlenbruch Markus A
机构信息
Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany.
Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany.
出版信息
Clin Neuroradiol. 2025 Aug 18. doi: 10.1007/s00062-025-01549-w.
BACKGROUND
Embolization of the middle meningeal artery (EMMA) is a promising novel technique for the treatment of patients with chronic subdural hematomas (cSDH).
METHODS
After a nationwide query in Germany, patients with cSDH, treated with EMMA were retrospectively analyzed. Patient and cSDH characteristics, procedural parameters, complications, and rates of treatment failure (TF; residual cSDH > 10 mm, cSDH progression or requirement of rescue surgery) were investigated. TF rates were compared between first-time treatments and treatments of recurrent cSDH, patients receiving embolization and surgery and those being embolized only, different types of embolic agents (particles vs. liquid agents) and between patients with and without antithrombotic medication.
RESULTS
718 EMMAs (420 unilateral, 149 bilateral) were performed in 569 patients in 30 German neurovascular centers. 57.1% were first-time treatments and 42.9% were treatments of recurrent cSDHs. The most frequently used embolic agents were particles (56.2%), followed by copolymer-based liquid embolic agents (19.6%). The rate of symptomatic procedure-related complications was 2.5%. After a mean follow-up of 6.5 months, TF was observed in 16.2% across all treatments and was more frequent after the treatment of recurrent cSDHs (19.8% vs. 13.5%, p = 0.045) and in patients taking antithrombotic drugs (17.7% vs. 11.5%; p = 0.044). TF was not significantly different regarding the type of embolic agent or additional surgery.
CONCLUSIONS
In this nationwide multi-center study, EMMA was associated with favorable clinical outcomes and a low complication rate, supporting the results of recently published randomized controlled trials. TF was more frequent in recurrent cSDH treatments and in patients taking antithrombotic drugs.
背景
脑膜中动脉栓塞术（EMMA）是一种治疗慢性硬膜下血肿（cSDH）患者的有前景的新技术。
方法
在德国进行全国范围查询后，对接受EMMA治疗的cSDH患者进行回顾性分析。研究患者和cSDH的特征、手术参数、并发症以及治疗失败率（TF；残余cSDH>10mm、cSDH进展或需要挽救性手术）。比较首次治疗与复发性cSDH治疗、接受栓塞和手术的患者与仅接受栓塞的患者、不同类型栓塞剂（颗粒与液体栓塞剂）以及服用和未服用抗血栓药物患者之间的TF率。
结果
德国30个神经血管中心的569例患者接受了718次EMMA治疗（420例单侧，149例双侧）。57.1%为首次治疗，42.9%为复发性cSDH治疗。最常用的栓塞剂是颗粒（56.2%），其次是基于共聚物的液体栓塞剂（19.6%）。症状性手术相关并发症发生率为2.5%。平均随访6.5个月后，所有治疗的TF率为16.2%，复发性cSDH治疗后更常见（19.8%对13.5%，p = 0.045），服用抗血栓药物的患者中也更常见（17.7%对11.5%；p = 0.044）。TF在栓塞剂类型或额外手术方面无显著差异。
结论
在这项全国性多中心研究中，EMMA具有良好的临床结局和较低的并发症发生率，支持最近发表的随机对照试验结果。复发性cSDH治疗和服用抗血栓药物的患者中TF更常见。
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