Abstract：
Chronic subdural hematomas (CSDHs) are common in the elderly population and patients taking antiplatelet/anticoagulation medications. Middle meningeal artery (MMA) embolization has become an adjunctive treatment to observation and surgery. Despite many embolization techniques, best practices for optimal CSDH resolution remain unknown.
To report a retrospective case series of MMA embolization for CSDHs regarding rate of hematoma improvement and the significance of distal embolic penetration into the falx.
Retrospective chart review was performed on all patients who underwent MMA embolization for CSDHs between January 2017 and June 2021. Patient demographics, clinical presentation, anticoagulant use, and radiographic features were collected. Pre-embolization and postembolization computed tomography scans were analyzed for volumetric changes and assessed for midline penetration of embolic material in the falx.
MMA embolization was performed in 37 patients and 53 hemispheres. Older patients took longer to obtain complete resolution of CSDHs (r = 0.47, P = .03). Patients with larger pre-embolization (r = 0.57, P = .007) and postembolization (r = 0.56, P = .008) CSDH volumes took longer to completely resolve. Patients who had n-butyl cyanoacrylate embolization with midline penetration, as evidenced by the \"bright falx\" sign, had faster improvement rates than those who did not (5.64 cm 3 /d vs 1.2 cm 3 /d, P = .02).
Distal penetration of embolic material, particularly n-butyl cyanoacrylate, into the falx may lead to more rapid improvement of CSDH.
To report a retrospective case series of MMA embolization for CSDHs regarding rate of hematoma improvement and the significance of distal embolic penetration into the falx.
Retrospective chart review was performed on all patients who underwent MMA embolization for CSDHs between January 2017 and June 2021. Patient demographics, clinical presentation, anticoagulant use, and radiographic features were collected. Pre-embolization and postembolization computed tomography scans were analyzed for volumetric changes and assessed for midline penetration of embolic material in the falx.
MMA embolization was performed in 37 patients and 53 hemispheres. Older patients took longer to obtain complete resolution of CSDHs (r = 0.47, P = .03). Patients with larger pre-embolization (r = 0.57, P = .007) and postembolization (r = 0.56, P = .008) CSDH volumes took longer to completely resolve. Patients who had n-butyl cyanoacrylate embolization with midline penetration, as evidenced by the \"bright falx\" sign, had faster improvement rates than those who did not (5.64 cm 3 /d vs 1.2 cm 3 /d, P = .02).
Distal penetration of embolic material, particularly n-butyl cyanoacrylate, into the falx may lead to more rapid improvement of CSDH.
摘要：
慢性硬膜下血肿（CSDHs）在老年人群和服用抗血小板/抗凝药物的患者中很常见。脑膜中动脉（MMA）栓塞已成为观察和手术的辅助治疗方法。尽管有许多栓塞技术，最佳CSDH分辨率的最佳实践仍然未知。
报告一系列关于血肿改善率和远端栓塞穿入镰刀的意义的MMA栓塞治疗CSDHs的回顾性病例。
对2017年1月至2021年6月期间接受MMA栓塞治疗CSDHs的所有患者进行回顾性图表回顾。患者人口统计学，临床表现,抗凝剂的使用,并收集了射线照相特征。分析了栓塞前和栓塞后计算机断层扫描的体积变化，并评估了栓塞材料在镰刀中的中线渗透。
在37例患者和53个半球中进行了MMA栓塞。老年患者需要更长的时间才能获得CSDHs的完全消退（r=0.47，P=0.03）。栓塞前（r=0.57，P=.007）和栓塞后（r=0.56，P=.008）CSDH体积较大的患者需要更长的时间才能完全解决。有中线渗透的氰基丙烯酸正丁酯栓塞的患者，正如“明亮的镰刀”标志所证明的那样，比没有的人有更快的改善率(5.64cm3/d比1.2cm3/d，P=.02）。
栓塞材料的远端穿透，特别是氰基丙烯酸正丁酯，进入Falx可能导致CSDH的更快改善。
报告一系列关于血肿改善率和远端栓塞穿入镰刀的意义的MMA栓塞治疗CSDHs的回顾性病例。
对2017年1月至2021年6月期间接受MMA栓塞治疗CSDHs的所有患者进行回顾性图表回顾。患者人口统计学，临床表现,抗凝剂的使用,并收集了射线照相特征。分析了栓塞前和栓塞后计算机断层扫描的体积变化，并评估了栓塞材料在镰刀中的中线渗透。
在37例患者和53个半球中进行了MMA栓塞。老年患者需要更长的时间才能获得CSDHs的完全消退（r=0.47，P=0.03）。栓塞前（r=0.57，P=.007）和栓塞后（r=0.56，P=.008）CSDH体积较大的患者需要更长的时间才能完全解决。有中线渗透的氰基丙烯酸正丁酯栓塞的患者，正如“明亮的镰刀”标志所证明的那样，比没有的人有更快的改善率(5.64cm3/d比1.2cm3/d，P=.02）。
栓塞材料的远端穿透，特别是氰基丙烯酸正丁酯，进入Falx可能导致CSDH的更快改善。
