应用Onyx栓塞脑膜中动脉治疗慢性硬膜下血肿的初步经验  

Onyx embolization of middle meningeal artery in the treatment of chronic subdural hematoma:a single-center experience

作　　者：盖延廷 郑佳佳 沈阳 李欢 杨毅 Gai Yanting;Zheng Jiajia;Shen Yang;Li Huan;Yang Yi(Department of Neurosurgery,Shanghai Donglei Brain Hospital,Shanghai 201702,China)

机构地区：[1]上海冬雷脑科医院神经外科,201702

出　　处：《中国脑血管病杂志》2022年第10期691-698,共8页Chinese Journal of Cerebrovascular Diseases

基　　金：上海市青浦区科技发展基金项目(QKY2021-45)。

摘　　要：目的分析Onyx栓塞脑膜中动脉治疗慢性硬膜下血肿(CSDH)的临床疗效和安全性。方法回顾性连续纳入上海冬雷脑科医院神经外科于2020年4月至2021年10月期间采用Onyx栓塞脑膜中动脉治疗的CSDH患者14例。收集患者的人口学资料及临床资料,人口学资料包括性别、年龄;临床资料包括外伤史、手术史、高血压病史、糖尿病史、高脂血症、颅内动脉瘤史、口服抗血小板聚集药物史、抗凝药物史以及口服他汀类药物史、临床症状(头痛、头晕、肢体乏力)、术前改良Rankin量表(mRS)评分、血肿特征(包括侧别、最大厚度、中线偏移程度)、手术入路方式(经桡动脉或经股动脉)、麻醉方式(局部麻醉或全身麻醉)、影像学资料(头部CT或MRI)、围手术期并发症(颅内感染、出血或脑梗死、失明、面瘫)发生情况。对于术前血肿最大厚度10~<20 mm同时中线偏移<10 mm的患者,采用单纯脑膜中动脉栓塞治疗(MMAE),若病程中出现因血肿体积增加导致的症状加重,则行补救性开颅钻孔引流术;术前测量血肿厚度≥20 mm,或者血肿厚度10~<20 mm但中线偏移≥10 mm的患者,采用MMAE联合颅骨钻孔引流术。术后3个月采用头部CT和(或)MRI复查残余血肿最大厚度,术后3个月门诊或电话随访评估患者mRS评分。影像学检查资料以血肿侧数(侧)表示,其余患者资料以例数(例)表示。结果共14例CSDH患者19侧血肿纳入本研究。术前mRS评分0分8例,1分4例,2分2例。6例(9侧)患者行单纯MMAE,8例(10侧)患者行MMAE联合颅骨钻孔引流术;共11例患者(15侧血肿)获得术后3个月CT和(或)MRI影像学随访,其中影像学治愈13/15侧,明显好转2/15侧。术后3个月随访,mRS评分0分12例,1分2例。6例头痛患者术后症状均恢复正常;3例头晕患者术后2例症状恢复正常;10例肢体乏力患者术后症状恢复正常9例。所有患者围手术期无颅内感染、出血或脑梗死、失明、面瘫等�Objective To evaluate and analyze the clinical efficacy and safety of middle meningeal artery(MMA)embolization with Onyx in the treatment of chronic subdural hematoma(CSDH).Methods The clinical data of 14 patients with CSDH treated by Onyx embolization of MMA in the Department of Neurosurgery,Shanghai Donglei Brain Hosipital from April 2020 to October 2021 were analyzed retrospectively.Demographic data and clinical data were collected.Demographic data included gender and age.Clinical data included past history(trauma,surgical history,hypertension,diabetes mellitus,hyperlipemia,intracerebral aneurysm),oral medications(anticoagulants,antiplatelets and statins),clinical symptoms(headache,dizziness,weakness),pre-operational modified Rankin scale(mRS)scores,hematoma characteristics(sides,maximal thickness,maximum midline shift),operation approach(transradial or transfemoral),and anesthesia(local or general).Radiological data included head CT or MRI.Perioperative complications included intracranial infection,bleeding,infarction,blindness and facial palsy.When the maximal hematoma thickness was 10-<20 mm and the maximal midline shift was<10 mm,middle meningeal artery embolization(MMAE)was performed;if the clinical symptom became worse due to enlargement of the hematoma,surgical drainage was done.When the maximal hematoma thickness was≥20 mm,or the maximal hematoma thickness was 10-<20 mm and the maximal midline shift was≥10 mm,MMAE combined with burr hole drainage was performed.Head CT or MRI examination was performed to evaluate the maximal thickness of residual hematoma and mRS score and symptoms improvement were evaluated by outpatient or telephone follow-up at 3 months after operation.Radiological data was recorded as the number of hematoma sides,and other data was recorded as the number of cases.Results Fourteen CSDH patients with 19 sides of hematoma were included in this study.The pre-operational mRS scores included 8 cases of 0,4 cases of 1 and 2 cases of 2.Six cases(9 sides)underwent MMAE alone,8 cases(10 s

关 键 词：血肿 硬膜下 慢性 脑膜动脉 治疗结果 手术后并发症 ONYX 

分 类 号：R651.15[医药卫生—外科学]