应用脑膜中动脉栓塞术治疗慢性硬脑膜下血肿的临床观察  

Clinical efficacy of middle meningeal artery embolization for the treatment of chronic subdural hematoma

作　　者：陈鲲鹏 陆军[1] 祁鹏[1] 王俊杰[1] 胡深[1] 杨希孟 邓颖[1] 裴傲[1] 王大明[1] Kunpeng Chen;Jun Lu;Peng Qi;Junjie Wang;Shen Hu;Ximeng Yang;Ying Deng;Ao Pei;Daming Wang(Department of Neurosurgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院神经外科,国家老年医学中心,中国医学科学院老年医学研究院,100730

出　　处：《中华脑血管病杂志（电子版）》2024年第3期236-242,共7页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：中央高水平医院临床科研业务费专项(BJ-2023-180)。

摘　　要：目的观察应用脑膜中动脉(MMA)栓塞术治疗慢性硬脑膜下血肿(cSDH)的临床疗效,并探讨cSDH患者可单纯应用MMA栓塞治疗成功的影响因素。方法回顾性连续纳入北京医院神经外科2021年7月至2023年11月间应用MMA栓塞治疗的33例cSDH患者,收集患者的人口学、临床和影像学资料,观察手术疗效及围手术期并发症情况,并进行临床和影像随访。根据是否联合应用钻孔引流术将患者分为单纯栓塞组和联合钻孔引流组,采用单因素分析(Fisher精确概率检验、t检验或Mann-Whitney U检验)进行组间上述资料的差异性比较,并应用多因素Logistic回归分析可单纯应用MMA栓塞治疗获得成功的影响因素。结果共33例患者43侧cSDH,22例患者单纯行MMA栓塞治疗成功,11例联合应用钻孔引流术。所有患者均取得技术上成功,1例患者术后发生面瘫,并发症发生率为3.0%(1/33)。共29例患者获得术后至少2周影像学随访,影像随访时间92.0(52.5,161.0)d,26例(89.7%)末次影像随访时cSDH最大血肿厚度较术前减少50%以上。33例患者临床随访时间为(304.9±190.5)d,93.9%(31/33)的患者神经功能较术前稳定或好转,无病例血肿复发。与联合钻孔引流组相比,单纯栓塞组患者年龄更小[(71.9±9.7)岁vs(81.4±9.9)岁,t=2.620,P=0.013],术前改良Rankin量表评分更低[2(1,3)分vs 4(2,4)分,Z=2.471,P=0.017],术前中线移位程度更轻[4.5(1.5,6.0)mm vs 8.0(7.0,9.0)mm,Z=3.618,P<0.001]。多因素Logistic回归分析结果显示,年龄较小(OR=0.63,95%CI:0.41~0.97,P=0.038)和术前中线移位程度较轻(OR=0.07,95%CI:0.01~0.72,P=0.026)是单纯MMA栓塞治疗成功的独立预测因素。结论初步观察显示,应用MMA栓塞治疗cSDH是安全有效的,并可作为首要治疗方式。年龄较小和中线移位程度较轻是cSDH患者可单纯应用MMA栓塞治疗成功的独立预测因素。Objective To assess the clinical efficacy of middle meningeal artery (MMA) embolization as a treatment for chronic subdural hematoma (cSDH) and to analyze the factors that contribute to the success of cSDH treatment using MMA embolization alone.MethodsWe retrospectively included 33 patients with cSDH who underwent MMA embolization at Neurosurgery Department of Beijing Hospital from July 2021 to November 2023. Demographic, clinical, and radiographic data were collected. Surgical outcomes, perioperative complications, and clinical and radiographic follow-up outcomes were also collected. Patients were categorized into two groups: those who received MMA embolization alone and those who also underwent concurrent burr hole drainage. Inter-group differences were compared, by univariate analysis (the Fisher exact, t-tests, or Mann-Whitney U tests) and multivariate Logistic regression analysis was performed to identify the factors influencing the success of treatment with MMA embolization alone.ResultsThirty-three patients with 43 sides affected by cSDH were included. MMA embolization alone was successful in 22 patients, while 11 patients also received concurrent burr-hole drainage. Technical success was achieved in all patients, with a complication rate of 3.0% (1/33) represented by one case of facial palsy. Among the 29 patients who had a minimum of 2 weeks imaging follow-up, the median imaging follow-up duration was 92.0 (52.5, 161.0) days, and 26 cases (89.7%) showed a reduction in maximum hematoma thickness ≥50% compared to preoperative measurements. The mean clinical follow-up duration for the 33 patients was (304.9±190.5) days, with 93.9% (31/33) of patients showing stable or improved neurological function compared to their preoperative status, and no cases of hematoma recurrence were observed. Compared to the concurrent with burr-hole drainage group, the MMA embolization alone group had a younger age [(71.9±9.7) years vs (81.4±9.9) years, t=2.620, P=0.013], a lower preoperative modified Rankin Scale score [2

关 键 词：慢性硬脑膜下血肿 脑膜中动脉 栓塞 血管内治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]