Impact of middle meningeal artery embolisation on management of chronic subdural haematoma in older people with frailty and antithrombotic therapy.

IF 0.8 4区医学 Q4 CLINICAL NEUROLOGY

British Journal of Neurosurgery Pub Date : 2026-10-01 Epub Date: 2026-03-10 DOI:10.1080/02688697.2026.2641472

Frances Rickard, Krishan Bansal, Alex Mortimer, Rebecca Dumas, Sarah Ibitoye, Robert Grange, Richard Flood, Anthony Cox, Timothy Raffan-Burnett, Adam Williams, Crispin Wigfield, David Jh Shipway

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引用次数: 0

Abstract

Background: Middle meningeal artery embolisation (MMAE) is a potential adjunct/alternative to conventional treatment of chronic subdural haematoma (cSDH) and is associated with reduced rates of recurrence and surgical rescue. However, real world reporting outcomes in older people with frailty have not yet been extensively described.

Methods: We undertook an observational analysis of all cSDH patients requiring intervention between November 2019 and December 2024. Patients received either MMAE (standalone/adjunctive) or burr holes alone.

Results: Ninety patients underwent MMAE (median age: 81, IQR: 76-86); 222 underwent burr holes alone (median age: 80, IQR: 74-85). MMAE was adjunctive in 64.4% of cases; these patients had more severe neurological impairment, larger haematoma depth, and greater degree of midline shift than patients undergoing standalone MMAE. 52.2% of MMAE patients had frailty. MMAE was associated with significantly reduced cSDH recurrence (7.8% vs. 19.8%, p = 0.009, OR 0.341 (95% CI 0.136-0.745)), and antithrombotic therapy was resumed earlier in patients treated with MMAE (8.5 vs. 14 days, p < 0.001). Adverse events following MMAE were low (1.1%).

Conclusions: In a real-world UK healthcare setting, including patients with frailty, MMAE is associated with reduced rates of clinically significant cSDH recurrence and may facilitate safer, earlier reintroduction of antithrombotic therapy.

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脑膜中动脉栓塞对虚弱老年人慢性硬膜下血肿和抗血栓治疗的影响。

背景：脑膜中动脉栓塞（MMAE）是慢性硬膜下血肿（cSDH）常规治疗的潜在辅助/替代方法，与降低复发率和手术抢救相关。然而，现实世界中报告老年人虚弱的结果尚未得到广泛描述。方法：我们对2019年11月至2024年12月期间需要干预的所有cSDH患者进行了观察性分析。患者接受MMAE（独立/辅助）或单独钻孔治疗。结果：90例患者行MMAE（中位年龄：81岁，IQR: 76-86）；222例单独行毛刺钻孔（中位年龄：80岁，IQR: 74-85）。64.4%的病例为MMAE辅助；与独立MMAE患者相比，这些患者有更严重的神经功能损害，更大的血肿深度和更大程度的中线移位。52.2%的MMAE患者虚弱。MMAE与显著降低cSDH复发率相关（7.8% vs. 19.8%, p = 0.009, OR 0.341 (95% CI 0.135 -0.745)），并且MMAE治疗的患者更早恢复抗血栓治疗（8.5 vs. 14天，p）。结论：在真实的英国医疗环境中，包括虚弱的患者，MMAE与临床显著cSDH复发率降低相关，并可能促进更安全、更早地重新引入抗血栓治疗。

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

British Journal of Neurosurgery 医学-临床神经学

CiteScore

2.30

自引率

9.10%

发文量

139

审稿时长

3-8 weeks

期刊介绍： The British Journal of Neurosurgery is a leading international forum for debate in the field of neurosurgery, publishing original peer-reviewed articles of the highest quality, along with comment and correspondence on all topics of current interest to neurosurgeons worldwide. Coverage includes all aspects of case assessment and surgical practice, as well as wide-ranging research, with an emphasis on clinical rather than experimental material. Special emphasis is placed on postgraduate education with review articles on basic neurosciences and on the theory behind advances in techniques, investigation and clinical management. All papers are submitted to rigorous and independent peer-review, ensuring the journal’s wide citation and its appearance in the major abstracting and indexing services.