Optimal Timeline and Hematoma Size Parameters for Middle Meningeal Artery Embolization in Acute-On-Chronic Subdural Hematomas.

IF 0.9 Q4 CLINICAL NEUROLOGY
Michael Fana, Giulia Santangelo, Abdalla Albanna, Ammar Jum'ah, Mohammed Rehman
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Abstract

Background and purpose: Chronic subdural hematomas (cSDH) are subdural collection of blood for which the current treatment option remains as surgical evacuation due to recurring focal inflammation and angiogenesis. An adjunctive therapeutic intervention is endovascular embolization of the middle meningeal artery (MMA) to cease the prolific cycle of angiogenesis. Few investigations have been made into the indications of this treatment modality regarding the intervention timeline and hematoma size for non-surgical candidates with acute-on-chronic subdural hematomas.

Methods: We examined the clinical outcomes of 19 patients with 31 acute-on-chronic SDHs undergone MMA embolization and highlighted preliminary trends in radiological and morbidity outcomes.

Results: Primary outcomes identified a 57.6% success rate for MMA embolization of acute-on-chronic SDHs defined as significantly reduced hematoma size (i.e. >50%) without recurring bleeds, peri-procedural complications, post-procedural neurological deficits, and need for post-procedural surgical evacuation. Subgroup analysis demonstrated a success rate of 90.9% in patients undergone embolization after a minimum 3-week delay from initial CT head study compared to 33.3% with early intervention as well as a success rate of 75% in patients presenting with a large (i.e. >10 mm) SDH compared to 30% for small SDH.

Conclusion: Our preliminary data in this retrospective cohort study demonstrates significantly improved outcomes of MMA embolization in patients presenting with large (>10 mm) acute-on-chronic SDHs and in patients undergone embolization after >3 weeks from initial CT head and symptomatic presentation.

急性硬膜下血肿中脑膜中动脉栓塞术的最佳时间和血肿大小参数
背景和目的:慢性硬膜下血肿(cSDH)是硬膜下积血,由于病灶炎症和血管生成反复发作,目前的治疗方法仍是手术清除。脑膜中动脉(MMA)的血管内栓塞术是一种辅助治疗手段,可阻止血管生成的大量循环。对于非手术治疗的急性-慢性硬膜下血肿患者,很少有人研究这种治疗方式在干预时间和血肿大小方面的适应症:我们研究了19例31个急性-慢性硬膜下血肿患者接受MMA栓塞治疗的临床结果,并强调了放射学和发病率结果的初步趋势:主要结果显示,急性-慢性 SDH 的 MMA 栓塞术成功率为 57.6%,即血肿明显缩小(即 >50%),且无复发出血、围手术期并发症、术后神经功能缺损以及术后手术排空需求。亚组分析显示,从最初的头部CT检查开始至少延迟3周后接受栓塞治疗的患者的成功率为90.9%,而早期干预的成功率为33.3%;大面积(即>10毫米)SDH患者的成功率为75%,而小面积SDH患者的成功率为30%:我们在这项回顾性队列研究中获得的初步数据表明,对于急性-慢性大面积(>10 毫米)SDH 患者,以及在首次头部 CT 检查后超过 3 周才接受栓塞治疗且出现症状的患者,MMA 栓塞治疗的疗效显著提高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Neurohospitalist
Neurohospitalist CLINICAL NEUROLOGY-
CiteScore
1.60
自引率
0.00%
发文量
108
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