Abstract：
BACKGROUND: The amount of midline shift (MLS) considered safe for middle meningeal artery embolization (MMAE) in patients with chronic subdural hematoma (CSDH) has not been established. Whether MMAE could be used as upfront treatment for unilateral large CSDH patients with significant MLS (>1 cm) has not been reported.
OBJECTIVE: To investigate the efficacy and safety of MMAE in unilateral large CSDH patients with MLS > 1 cm.
METHODS: Eleven carefully selected CSDH patients with mild or moderate symptoms and significant MLS > 1 cm from 1 May 2021 to 31 August 2022 were included in the study. All patients were treated with MMAE using polyvinyl alcohol (PVA) particles. Outcomes were assessed clinically and with interval imaging studies at follow-up.
RESULTS: All 19 MMAs (unilateral embolization in three patients and bilateral embolization in eight patients) were successfully embolized. All 11 patients were followed for subsequent months, and there was no recurrence and enlargement of CSDH. Procedural adverse events, mortality, or complications were not observed. The average time to achieve a 50% reduction in MLS was approximately four weeks, while it took approximately eight weeks to achieve a 50% reduction in maximal volume. All 11 patients showed improvement in their neurological symptoms at three days post-operation, including four hemiplegic patients.
CONCLUSIONS: MMAE may demonstrate safety in carefully selected CSDH patients with significant midline shift (MLS > 1 cm), particularly in those who are not suitable for surgery, thus providing a potential alternative approach.
OBJECTIVE: To investigate the efficacy and safety of MMAE in unilateral large CSDH patients with MLS > 1 cm.
METHODS: Eleven carefully selected CSDH patients with mild or moderate symptoms and significant MLS > 1 cm from 1 May 2021 to 31 August 2022 were included in the study. All patients were treated with MMAE using polyvinyl alcohol (PVA) particles. Outcomes were assessed clinically and with interval imaging studies at follow-up.
RESULTS: All 19 MMAs (unilateral embolization in three patients and bilateral embolization in eight patients) were successfully embolized. All 11 patients were followed for subsequent months, and there was no recurrence and enlargement of CSDH. Procedural adverse events, mortality, or complications were not observed. The average time to achieve a 50% reduction in MLS was approximately four weeks, while it took approximately eight weeks to achieve a 50% reduction in maximal volume. All 11 patients showed improvement in their neurological symptoms at three days post-operation, including four hemiplegic patients.
CONCLUSIONS: MMAE may demonstrate safety in carefully selected CSDH patients with significant midline shift (MLS > 1 cm), particularly in those who are not suitable for surgery, thus providing a potential alternative approach.
摘要：
背景：慢性硬膜下血肿（CSDH）患者中脑膜中动脉栓塞（MMAE）被认为安全的中线移位（MLS）量尚未确定。MMAE是否可以用作单侧大CSDH患者的早期治疗，MLS显著（>1cm）尚未报道。
目的：探讨MMAE对MLS>1cm的单侧大CSDH患者的疗效和安全性。
方法：在2021年5月1日至2022年8月31日期间，11名精心挑选的轻度或中度症状和显著MLS>1cm的CSDH患者被纳入研究。所有患者均使用聚乙烯醇（PVA）颗粒进行MMAE治疗。临床评估结果并在随访时进行间隔成像研究。
结果：所有19例MMA（3例患者单侧栓塞，8例患者双侧栓塞）均成功栓塞。所有11名患者均接受了随后几个月的随访，并且没有CSDH的复发和扩大。程序性不良事件，死亡率,或未观察到并发症。MLS减少50%的平均时间约为四周，而花了大约八周的时间才能使最大体积减少50％。所有11例患者在术后3天神经系统症状均有改善,包括四名偏瘫患者。
结论：MMAE可能在精心选择的具有明显中线移位（MLS>1cm）的CSDH患者中显示出安全性，特别是那些不适合手术的人，从而提供了一种潜在的替代方法。
目的：探讨MMAE对MLS>1cm的单侧大CSDH患者的疗效和安全性。
方法：在2021年5月1日至2022年8月31日期间，11名精心挑选的轻度或中度症状和显著MLS>1cm的CSDH患者被纳入研究。所有患者均使用聚乙烯醇（PVA）颗粒进行MMAE治疗。临床评估结果并在随访时进行间隔成像研究。
结果：所有19例MMA（3例患者单侧栓塞，8例患者双侧栓塞）均成功栓塞。所有11名患者均接受了随后几个月的随访，并且没有CSDH的复发和扩大。程序性不良事件，死亡率,或未观察到并发症。MLS减少50%的平均时间约为四周，而花了大约八周的时间才能使最大体积减少50％。所有11例患者在术后3天神经系统症状均有改善,包括四名偏瘫患者。
结论：MMAE可能在精心选择的具有明显中线移位（MLS>1cm）的CSDH患者中显示出安全性，特别是那些不适合手术的人，从而提供了一种潜在的替代方法。
