Single-session versus staged approaches for chronic subdural hematoma treatment with middle meningeal artery embolization and evacuation surgery: a propensity score-matched analysis.
Santiago Gomez-Paz, Mohamed M Salem, Kent R Richter, Margaret McGrath, Jeffrey M Breton, Ahmed Aljuboori, Philipp Hendrix, Gregory M Weiner, Alana M McNulty, Jane Khalife, Okkes Kuybu, Michael J Lang, Omar Tanweer, Daniel A Tonetti, Christopher S Ogilvy, Alejandro M Spiotta, Ajith J Thomas, Bradley A Gross, Edward A M Duckworth, Jan-Karl Burkhardt, Visish M Srinivasan, Thomas Snyder, Brian T Jankowitz, Michael R Levitt, Rocco A Armonda, Daniel R Felbaum, Alexandra R Paul, William J Ares, Ramesh Grandhi
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引用次数: 0
Abstract
Objective: Surgical evacuation is the mainstay of treatment for patients with chronic subdural hematoma (cSDH) who have symptomatic mass effect, yet it carries a recurrence risk of up to 20%. Recent randomized trials have shown that adding middle meningeal artery embolization (MMAE) can significantly reduce both reoperations and overall treatment failures. However, whether performing MMAE and surgical evacuation in a single session impacts treatment efficacy remains an open question.
Methods: The authors retrospectively identified 429 patients across 14 institutions who underwent MMAE plus surgical evacuation of cSDH. Patients were stratified into single-session (MMAE and evacuation under the same anesthesia session) or staged (separate sessions) cohorts. Baseline demographic, procedural, and imaging data were collected. Propensity score matching was performed to balance key baseline variables. Primary outcomes included hematoma recurrence, hospital length of stay (LOS), and functional independence (modified Rankin Scale score ≤ 2).
Results: Of 429 patients, 205 (47.8%) received single-session treatment. In the unmatched analysis, single-session patients showed a lower rate of cSDH reaccumulation and repeat surgery (4.7% vs 10.7%, p = 0.010) and a shorter median LOS (6 vs 7 days, p < 0.005). After matching, reaccumulation rates were not significantly different, but LOS remained significantly shorter (5 vs 7 days, p = 0.002). Functional outcomes and overall mortality were similar in both groups. Complication rates did not differ, and MMAE-related adverse events were rare.
Conclusions: Single-session MMAE plus surgical evacuation appears to be safe and shortens LOS compared with a staged approach. The rates of functional outcomes, re-evacuation, and mortality did not differ significantly from those observed in patients who underwent staged procedures.
目的：手术引流是慢性硬膜下血肿（cSDH）患者的主要治疗方法，但其复发风险高达20%。最近的随机试验表明，添加脑膜中动脉栓塞（MMAE）可以显著减少再手术和总体治疗失败。然而，在一次手术中进行MMAE和手术疏散是否会影响治疗效果仍然是一个悬而未决的问题。方法：作者回顾性分析了来自14家机构的429例接受MMAE加cSDH手术清除的患者。患者被分为单阶段（MMAE和在同一麻醉阶段下撤离）或分阶段（分开的阶段）队列。收集基线人口统计学、程序和影像学数据。进行倾向评分匹配以平衡关键基线变量。主要结局包括血肿复发、住院时间（LOS）和功能独立性（修正Rankin量表评分≤2）。结果：在429例患者中，205例（47.8%）接受了单疗程治疗。在非匹配分析中，单次手术患者的cSDH再积累率和重复手术率较低（4.7% vs 10.7%, p = 0.010），中位LOS较短（6 vs 7天，p < 0.005）。配对后，再积累率无显著差异，但LOS仍明显较短（5天vs 7天，p = 0.002）。两组的功能结局和总死亡率相似。并发症发生率无差异，mmae相关不良事件罕见。结论：与分阶段入路相比，单次MMAE加手术疏散似乎是安全的，并且缩短了LOS。功能结局、再疏散率和死亡率与分期手术的患者没有显著差异。
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