背景:脑膜中动脉栓塞术(MMAE)治疗慢性硬膜下血肿(CSDH)近年来备受关注。然而,当使用液体栓塞剂或颗粒时,可能会发生意外栓塞。我们介绍了我们在简单卷绕MMAE以管理CSDH方面的临床经验。
方法:对CSDH患者进行手术疏散或简单卷绕的MMAE。入院时评估临床和影像学结果,1个月,和6个月的间隔。两个治疗组以治疗加权的逆概率进行匹配。
结果:包括112例患者,MMAE组27例,手术组87例。在MMAE组中,血肿宽度显著减少(入院与1个月,2.04[1.44-2.60]cmvs.0.62[0.37-0.95]厘米,p<0.001)。手术抢救率的调整比值比(AOR)(0.7795CI0.13-4.47,p=0.77),血肿减少(>50%)(0.2195CI0.04-1.07,p=0.06),和中线移位改善率(3.22,95CI0.84-12.4,p=0.09)在1个月随访时两组之间没有实质性差异。此外,随访6个月时,两组间血肿减少(>50%)无显著差异(aOR1.0995CI0.32-3.70,p=0.89).MMA栓塞组无手术相关并发症发生。
结论:MMA的简单盘绕与CSDH的手术疏散具有相当的结果。我们的发现表明,简单的卷绕可以作为CSDHMMA栓塞中液体试剂或颗粒的替代选择,安全性可接受。
BACKGROUND: Middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) has gained much attention in recent years. However, unintended embolization may occur when employing liquid embolic agents or particles. We present our clinical experience in simple coiling of MMAE to manage CSDH.
METHODS: Patients underwent either surgical evacuation or MMAE with simple coiling for CSDH were reviewed. Clinical and radiographic outcomes were assessed at admission, 1-month, and 6-month intervals. Two treatment groups were matched with inverse probability of treatment weighting.
RESULTS: One hundred twelve patients were included, with 27 patients in MMAE group and 87 patients in surgery group. In MMAE group, significant reductions were observed in hematoma width (admission vs. 1-month, 2.04 [1.44-2.60] cm vs. 0.62 [0.37-0.95] cm, p < 0.001). The adjusted odds ratio (aOR) of surgical rescue rate (0.77 95%CI 0.13-4.47, p = 0.77), hematoma reduction (>50%) (0.21 95%CI 0.04-1.07, p = 0.06), and midline shift improvement rate (3.22, 95%CI 0.84-12.4, p = 0.09) had no substantial disparities between two groups at 1-month follow-up. In addition, no significant difference was noted between two groups in terms of hematoma reduction (>50%) at 6-month follow-up (aOR 1.09 95%CI 0.32-3.70, p = 0.89). No procedure-related complications were found in MMA embolization group.
CONCLUSIONS: Simple coiling for MMA had comparable outcomes with surgical evacuation for CSDH. Our findings suggest that simple coiling can be an alternative choice for liquid agents or particles in MMA embolization for CSDH with acceptable safety.