Tian Ju
Department of Burns and Plastic Surgery, Zhongshan City People's Hospital, Zhongshan 528400, Guangdong Province, China.
World J Clin Cases. 2025 Oct 6;13(28):109679. doi: 10.12998/wjcc.v13.i28.109679.
Middle meningeal artery embolization (MMAE) has revolutionized chronic subdural hematoma management, yet procedural risks persist due to anatomical variability. We analyze a case report by Zhao describing transient diplopia caused by inadvertent embolization of the lacrimal artery a dynamic middle meningeal-ophthalmic anastomosis. This correspondence advances three critical innovations in MMAE safety. First, intraoperative anastomotic unmasking-exposing occult middle meningeal-ophthalmic collaterals during particle injection-reveals dynamic vascular behavior missed by preoperative angiography, underscoring the need for adaptive imaging protocols. Second, hybrid embolization (liquid agents for proximal occlusion + particles for distal control) balances precision and safety, reducing reflux risks compared to monotherapy. Third, a 108-day follow-up establishes a benchmark for functional recovery, challenging assumptions about irreversible cranial nerve injuries and emphasizing structured postprocedural care. Collectively, these findings advocate for procedural agility, multimodal embolic strategies, and sustained rehabilitation to optimize MMAE outcomes while minimizing iatrogenic harm.
脑膜中动脉栓塞术（MMAE）彻底改变了慢性硬膜下血肿的治疗方式，但由于解剖结构的变异性，手术风险依然存在。我们分析了赵的一篇病例报告，该报告描述了因泪腺动脉意外栓塞导致的短暂性复视，泪腺动脉是一种动态的脑膜中动脉-眼动脉吻合。这封信提出了MMAE安全性方面的三项关键创新。首先，术中吻合口暴露——在注射颗粒期间暴露隐匿的脑膜中动脉-眼动脉侧支——揭示了术前血管造影遗漏的动态血管行为，强调了采用适应性成像方案的必要性。其次，混合栓塞（近端闭塞使用液体剂 + 远端控制使用颗粒）平衡了精确性和安全性，与单一疗法相比降低了反流风险。第三，108天的随访为功能恢复建立了一个基准，挑战了关于不可逆性颅神经损伤的假设，并强调了结构化的术后护理。总体而言，这些发现提倡手术灵活性、多模式栓塞策略和持续康复，以优化MMAE的结果，同时将医源性伤害降至最低。
