Middle Meningeal Artery Embolization versus Surgery in Patients with Chronic Subdural Hematoma—No More Fence Sitting?

IF 3.2 Q2 CLINICAL NEUROLOGY Neurology International Pub Date : 2023-12-06 DOI:10.3390/neurolint15040096
Dalibor Sila, Francisco Luis Casnati, Mária Vojtková, Philipp Kirsch, Stefan Rath, František Charvát
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Abstract

Background: Endovascular treatment of patients with chronic subdural hematoma using middle meningeal artery (MMA) embolization could become an alternative to surgical hematoma evacuation. The aim of the study was to compare methods and identify parameters to help determine the correct treatment modality. Methods: We retrospectively reviewed 142 cases conducted internally; 78 were treated surgically and 64 were treated using MMA embolization. We analyzed the treatment failure rate and complications, and using a binary logistic regression model, we identified treatment failure risk factors. Results: We found a comparable treatment failure rate of 23.1% for the surgery group and 21.9% for the MMA embolization group. However, in the MMA embolization group, 11 cases showed treatment failure due to early neurological worsening with a need for concomitant surgery. We also found a recurrence of hematoma in 15.4% of cases in the surgery group and 6.3% of cases in the MMA embolization group. Conclusion: Both modalities have their advantages; however, correct identification is crucial for treatment success. According to our findings, hematomas with a maximal width of <18 mm, a midline shift of <5 mm, and no acute or subacute (hyperdense) hematoma could be treated with MMA embolization. Hematomas with a maximal width of >18 mm, a midline shift of >5 mm, and no membranous segmentation could have better outcomes after surgical treatment.
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慢性硬膜下血肿患者的中脑膜动脉栓塞术与手术治疗--不再围栏而坐?
背景:脑膜中动脉(MMA)栓塞治疗慢性硬膜下血肿可能成为手术血肿清除的替代方法。该研究的目的是比较方法和确定参数,以帮助确定正确的治疗方式。方法:回顾性分析142例内部病例;手术治疗78例,MMA栓塞治疗64例。我们分析了治疗失败率和并发症,并使用二元logistic回归模型,我们确定了治疗失败的危险因素。结果:我们发现手术组的治疗失败率为23.1%,MMA栓塞组的治疗失败率为21.9%。然而,在MMA栓塞组中,11例由于早期神经系统恶化而出现治疗失败,需要进行伴随手术。我们还发现,15.4%的手术组和6.3%的MMA栓塞组血肿复发。结论:两种模式各有优势;然而,正确的识别是治疗成功的关键。根据我们的研究结果,血肿最大宽度为18mm,中线移位> 5mm,无膜分割,手术治疗后效果较好。
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来源期刊
Neurology International
Neurology International CLINICAL NEUROLOGY-
CiteScore
3.70
自引率
3.30%
发文量
69
审稿时长
11 weeks
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