Jaims Lim, Vinay Jaikumar, Alexandra R Paul, Matthew Cullen, Christopher P Kellner, J Mocco, Brandon D Philbrick, Kunal Vakharia, Patrick Wahlig, Marissa D Kruk, Kenneth V Snyder, Elad I Levy, Jason M Davies, Adnan H Siddiqui
{"title":"硬膜下疏散口系统（SEPS）和脑膜中动脉栓塞（MMAE）治疗慢性硬膜下血肿的有效性-一个多中心的经验。","authors":"Jaims Lim, Vinay Jaikumar, Alexandra R Paul, Matthew Cullen, Christopher P Kellner, J Mocco, Brandon D Philbrick, Kunal Vakharia, Patrick Wahlig, Marissa D Kruk, Kenneth V Snyder, Elad I Levy, Jason M Davies, Adnan H Siddiqui","doi":"10.1136/jnis-2025-023489","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Craniotomy for subdural hematoma (SDH) in elderly patients with comorbidities can be challenging. The Subdural Evacuating Port System (SEPS; Medtronic, Minneapolis, MN) offers a less invasive alternative, while middle meningeal artery embolization (MMAE) has shown effectiveness in preventing SDH recurrence. We evaluated the combined effectiveness of SEPS+MMAE for chronic SDH (cSDH) treatment.</p><p><strong>Methods: </strong>Retrospective database reviews were conducted. Demographic, comorbidity, procedural, and outcomes data were analyzed. cSDH resolution was tracked by measuring hematoma volumes on noncontrast computed tomograms pre-SEPS+MMAE, 24-48 hours post-SEPS+MMAE, and 6-8 weeks afterward (follow-up-SEPS+MMAE).</p><p><strong>Results: </strong>Our study included 114 patients (median age: 77 years (interquartile range (IQR): 69-83 years); men: women=74:40) with 134 cSDHs treated with SEPS+MMAE were included. Median pre-SEPS+MMAE cSDH volume was 122.9 mL (88-152.4 mL) with midline shift of 6 mm (3.4-9.5 mm). Most MMAE procedures were performed under general anesthesia (68.7%), utilizing the femoral approach (61.9%) and particle embolic agents (55.2%). In-hospital rescue craniotomy was required after 10 (7.5%) procedures. Median post-SEPS+MMAE and follow-up-SEPS+MMAE cSDH volume reductions were 71.1 mL (54.1-94.8 mL) and 23.4 mL (2-56.3 mL), respectively, resulting in 38.1% (22.1-52.9%) and 79.9% (51-97.8%) reductions, respectively. Of 109 patients with follow-up, 10 (9.2%) were readmitted for cSDH residual/recurrence within 90 days, eight (7.3%) required retreatment: five (4.6%) with craniotomy, three (2.8%) with SEPS. Hyperlipidemia (P=0.002), anticoagulant use (P=0.036), and larger pre-SEPS+MMAE cSDH volume (P<0.001) predicted greater SEPS-mediated clearance. Older age (P=0.03), coronary artery disease (P=0.004), membranes within cSDH (P=0.039), acute/subacute components in cSDH (P=0.047), and unilateral cSDH (P=0.017) predicted less SEPS-mediated clearance. Older age (P=0.006), acute/subacute components in cSDH (P=0.016), and longer follow-up (P=0.013) predicted higher MMAE effectiveness. Higher pre-SEPS+MMAE cSDH volume (P=0.047) and unilateral MMAE for bilateral cSDH (P=0.036) predicted lower MMAE effectiveness.</p><p><strong>Conclusion: </strong>SEPS+MMAE was an effective, safe treatment for cSDH.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3000,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effectiveness of subdural evacuating port system (SEPS) and middle meningeal artery embolization (MMAE) for chronic subdural hematomas - a multicenter experience.\",\"authors\":\"Jaims Lim, Vinay Jaikumar, Alexandra R Paul, Matthew Cullen, Christopher P Kellner, J Mocco, Brandon D Philbrick, Kunal Vakharia, Patrick Wahlig, Marissa D Kruk, Kenneth V Snyder, Elad I Levy, Jason M Davies, Adnan H Siddiqui\",\"doi\":\"10.1136/jnis-2025-023489\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Craniotomy for subdural hematoma (SDH) in elderly patients with comorbidities can be challenging. The Subdural Evacuating Port System (SEPS; Medtronic, Minneapolis, MN) offers a less invasive alternative, while middle meningeal artery embolization (MMAE) has shown effectiveness in preventing SDH recurrence. We evaluated the combined effectiveness of SEPS+MMAE for chronic SDH (cSDH) treatment.</p><p><strong>Methods: </strong>Retrospective database reviews were conducted. Demographic, comorbidity, procedural, and outcomes data were analyzed. cSDH resolution was tracked by measuring hematoma volumes on noncontrast computed tomograms pre-SEPS+MMAE, 24-48 hours post-SEPS+MMAE, and 6-8 weeks afterward (follow-up-SEPS+MMAE).</p><p><strong>Results: </strong>Our study included 114 patients (median age: 77 years (interquartile range (IQR): 69-83 years); men: women=74:40) with 134 cSDHs treated with SEPS+MMAE were included. Median pre-SEPS+MMAE cSDH volume was 122.9 mL (88-152.4 mL) with midline shift of 6 mm (3.4-9.5 mm). Most MMAE procedures were performed under general anesthesia (68.7%), utilizing the femoral approach (61.9%) and particle embolic agents (55.2%). In-hospital rescue craniotomy was required after 10 (7.5%) procedures. Median post-SEPS+MMAE and follow-up-SEPS+MMAE cSDH volume reductions were 71.1 mL (54.1-94.8 mL) and 23.4 mL (2-56.3 mL), respectively, resulting in 38.1% (22.1-52.9%) and 79.9% (51-97.8%) reductions, respectively. Of 109 patients with follow-up, 10 (9.2%) were readmitted for cSDH residual/recurrence within 90 days, eight (7.3%) required retreatment: five (4.6%) with craniotomy, three (2.8%) with SEPS. Hyperlipidemia (P=0.002), anticoagulant use (P=0.036), and larger pre-SEPS+MMAE cSDH volume (P<0.001) predicted greater SEPS-mediated clearance. Older age (P=0.03), coronary artery disease (P=0.004), membranes within cSDH (P=0.039), acute/subacute components in cSDH (P=0.047), and unilateral cSDH (P=0.017) predicted less SEPS-mediated clearance. Older age (P=0.006), acute/subacute components in cSDH (P=0.016), and longer follow-up (P=0.013) predicted higher MMAE effectiveness. 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引用次数: 0
摘要
背景：老年患者硬膜下血肿（SDH）合并症的开颅治疗具有挑战性。硬膜下疏散系统；美敦力公司（Medtronic, Minneapolis， MN）提供了一种侵入性较小的替代方案，而脑膜中动脉栓塞（MMAE）已显示出预防SDH复发的有效性。我们评估了SEPS+MMAE联合治疗慢性SDH （cSDH）的有效性。方法：进行回顾性数据库分析。对人口统计学、合并症、手术和结局数据进行分析。通过测量seps +MMAE前、seps +MMAE后24-48小时和seps +MMAE后6-8周（随访- seps +MMAE）的非对比计算机断层扫描血肿体积来跟踪cSDH的分辨率。结果：我们的研究纳入了114例患者(中位年龄：77岁（四分位间距（IQR）： 69-83岁）；男性：女性=74:40)，包括134例经SEPS+MMAE治疗的cSDHs。seps +MMAE前cSDH体积中位数为122.9 mL (88-152.4 mL)，中线偏移6mm （3.4-9.5 mm）。大多数MMAE手术在全麻下进行（68.7%），利用股骨入路（61.9%）和颗粒栓塞剂（55.2%）。10例（7.5%）手术后需要进行院内抢救开颅手术。seps +MMAE和随访- seps +MMAE后cSDH体积减少的中位数分别为71.1 mL （54.1-94.8 mL）和23.4 mL (2-56.3 mL)，分别减少38.1%（22.1-52.9%）和79.9%（51-97.8%）。109例随访患者中，10例（9.2%）在90天内因cSDH残留/复发再次入院，8例（7.3%）需要再治疗：5例（4.6%）开颅，3例（2.8%）SEPS。高脂血症（P=0.002）、抗凝剂使用（P=0.036）和较大的前SEPS+MMAE cSDH体积(P)结论：SEPS+MMAE是一种有效、安全的cSDH治疗方法。
Effectiveness of subdural evacuating port system (SEPS) and middle meningeal artery embolization (MMAE) for chronic subdural hematomas - a multicenter experience.
Background: Craniotomy for subdural hematoma (SDH) in elderly patients with comorbidities can be challenging. The Subdural Evacuating Port System (SEPS; Medtronic, Minneapolis, MN) offers a less invasive alternative, while middle meningeal artery embolization (MMAE) has shown effectiveness in preventing SDH recurrence. We evaluated the combined effectiveness of SEPS+MMAE for chronic SDH (cSDH) treatment.
Methods: Retrospective database reviews were conducted. Demographic, comorbidity, procedural, and outcomes data were analyzed. cSDH resolution was tracked by measuring hematoma volumes on noncontrast computed tomograms pre-SEPS+MMAE, 24-48 hours post-SEPS+MMAE, and 6-8 weeks afterward (follow-up-SEPS+MMAE).
Results: Our study included 114 patients (median age: 77 years (interquartile range (IQR): 69-83 years); men: women=74:40) with 134 cSDHs treated with SEPS+MMAE were included. Median pre-SEPS+MMAE cSDH volume was 122.9 mL (88-152.4 mL) with midline shift of 6 mm (3.4-9.5 mm). Most MMAE procedures were performed under general anesthesia (68.7%), utilizing the femoral approach (61.9%) and particle embolic agents (55.2%). In-hospital rescue craniotomy was required after 10 (7.5%) procedures. Median post-SEPS+MMAE and follow-up-SEPS+MMAE cSDH volume reductions were 71.1 mL (54.1-94.8 mL) and 23.4 mL (2-56.3 mL), respectively, resulting in 38.1% (22.1-52.9%) and 79.9% (51-97.8%) reductions, respectively. Of 109 patients with follow-up, 10 (9.2%) were readmitted for cSDH residual/recurrence within 90 days, eight (7.3%) required retreatment: five (4.6%) with craniotomy, three (2.8%) with SEPS. Hyperlipidemia (P=0.002), anticoagulant use (P=0.036), and larger pre-SEPS+MMAE cSDH volume (P<0.001) predicted greater SEPS-mediated clearance. Older age (P=0.03), coronary artery disease (P=0.004), membranes within cSDH (P=0.039), acute/subacute components in cSDH (P=0.047), and unilateral cSDH (P=0.017) predicted less SEPS-mediated clearance. Older age (P=0.006), acute/subacute components in cSDH (P=0.016), and longer follow-up (P=0.013) predicted higher MMAE effectiveness. Higher pre-SEPS+MMAE cSDH volume (P=0.047) and unilateral MMAE for bilateral cSDH (P=0.036) predicted lower MMAE effectiveness.
Conclusion: SEPS+MMAE was an effective, safe treatment for cSDH.
期刊介绍：
The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.
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