Orscelik Atakan, Senol Yigit Can, Chaney Eli, Narsinh Kazim, Amans Matthew, Raper Daniel Ms, Winkler Ethan, Hetts Steven, Cooke Daniel, Savastano Luis E
Department of Neurological Surgery, University of California, San Francisco, CA, USA.
Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
Interv Neuroradiol. 2025 Aug 25:15910199251370600. doi: 10.1177/15910199251370600.
ObjectiveRecurrent or growing non-acute subdural hematoma (SDH) following standalone or adjunctive middle meningeal artery embolization (MMAe) present a complex clinical challenge. This study aims to investigate the multifactorial causes of recurrence and growing SDH, including vascular and systemic contributors, and explores management strategies to improve outcomes.MethodsWe conducted a retrospective analysis of 22 patients with non-acute SDH requiring rescue treatment after adjunctive or stand-alone MMAe. Patients with documented trauma deemed responsible for the SDH expansion were excluded. Data were collected on patient demographics, clinical presentations, imaging findings, treatment approaches, and outcomes. A systematic review was also conducted across PubMed, Web of Science, Scopus, and Embase databases, adhering to PRISMA guidelines.ResultsNon-traumatic recurrent or growing SDHs were associated with MMA recanalization (27%), contralateral supply from the contralateral MMA (27%), CSF-venous fistulas (5%), and recruitments of vascular collaterals such as deep temporal artery (5%). Management strategies included, respectively, repeat MMAe using polyvinyl alcohol particles, coils, and liquid agents; contralateral MMAe, transvenous embolization for CSF-venous fistulas; and targeted embolization for other vascular contributors. Follow-up assessments were available for 14 patients (64%). Of these, 10 patients (45%) achieved complete resolution of symptoms, three patients (14%) experienced symptomatic improvement, and one patient (5%) had worsening symptoms. In terms of hematoma resolution, nine patients (41%) had complete or near-complete resolution, three patients (14%) exhibited stable hematoma size, and two patients (9%) demonstrated a reduction in hematoma size. Notably, no recurrences were observed after the final treatment. Two patients (9%) died within 10 days of the final embolization treatment due to malignancies.ConclusionRecurrent or growing SDHs following MMAe are linked to subdural membrane vascularity and intracranial hypotension which must be investigated and addressed. Treatment of these issues results in high cure rates.
目的
单独或辅助性脑膜中动脉栓塞术（MMAe）后复发性或增大性非急性硬膜下血肿（SDH）带来了复杂的临床挑战。本研究旨在调查复发性和增大性SDH的多因素病因，包括血管和全身因素，并探索改善治疗结果的管理策略。
方法
我们对22例在辅助性或单独MMAe后需要抢救治疗的非急性SDH患者进行了回顾性分析。排除有记录的创伤被认为是导致SDH扩大原因的患者。收集了患者的人口统计学资料、临床表现、影像学检查结果、治疗方法和治疗结果。还按照PRISMA指南对PubMed、科学网、Scopus和Embase数据库进行了系统综述。
结果
非创伤性复发性或增大性SDH与脑膜中动脉再通（27%）、对侧脑膜中动脉的对侧供血（27%）、脑脊液-静脉瘘（5%）以及颞深动脉等血管侧支的新生（5%）有关。管理策略分别包括使用聚乙烯醇颗粒、弹簧圈和液体栓塞剂重复进行MMAe；对侧MMAe、经静脉栓塞治疗脑脊液-静脉瘘；以及针对其他血管因素进行靶向栓塞。14例患者（64%）进行了随访评估。其中，10例患者（45%）症状完全缓解，3例患者（14%）症状改善，1例患者（5%）症状恶化。在血肿消退方面，9例患者（41%）完全或接近完全消退，3例患者（14%）血肿大小稳定，2例患者（9%）血肿大小缩小。值得注意的是，最终治疗后未观察到复发情况。2例患者（9%）在最后一次栓塞治疗后10天内死于恶性肿瘤。
结论
MMAe后复发性或增大性SDH与硬膜下膜血管形成和颅内低压有关，必须进行调查和处理。对这些问题的治疗可获得较高的治愈率。
