Background

Chronic subdural hematoma (CSDH) is a common condition requiring surgical treatment, however, recurrence occurs in 9-26% of cases. Middle meningeal artery (MMA) embolization has recently emerged as a promising treatment to prevent CSDH recurrence.

Objective

To investigate the effect of MMA embolization on hematoma volume resorption (HVR) after surgery in symptomatic patients.

Materials and methods

From April 2018 to October 2018, participants with CSDH requiring surgery were prospectively randomized in a pilot study, and received either surgical treatment alone (ST group) or surgery and adjuvant MMA embolization (ST + MMAE group). The primary outcome was HVR measured on the 3-month CT scan compared to the immediate pre-embolization CT scan. Secondary outcomes were clinical recurrence of CSDH and safety measures.

Results

Forty-six patients were randomized and 41 of these were present at 3-month follow-up (23 women, mean age 75.9 ± 12.5 years). Twenty-one patients received MMA embolization. At 3 months, the HVR from post-surgical level was higher in the ST + MMAE group (mean difference: 17.5 mL; 95% Confidence Interval, 3.87 to 31.16 mL; P=.015). Two participants presented a CSDH recurrence (one in each group). One patient died (ST group), and no MMA embolization-related adverse events were reported.

Conclusion

Addition of middle meningeal embolization to surgery led to an increase of subdural chronic hematoma resorption at 3 months. One recurrence of chronic subdural hematoma was reported in each group, and there were no treatment-related complications.

中文翻译：

---

脑膜中动脉栓塞术作为有症状的慢性硬膜下血肿手术的辅助治疗：评估血肿体积吸收的初步研究

背景

慢性硬脑膜下血肿（CSDH）是需要手术治疗的常见疾病，但是，复发的病例在9-26％的病例中。脑膜中动脉（MMA）栓塞术最近成为预防CSDH复发的有前途的治疗方法。

目的

目的探讨有症状患者手术后MMA栓塞对血肿体积吸收（HVR）的影响。

材料和方法

从2018年4月到2018年10月，将需要手术的CSDH参与者在一项前瞻性研究中进行前瞻性随机分组，并接受单独的手术治疗（ST组）或手术和MMA栓塞辅助治疗（ST + MMAE组）。主要结果是与栓塞前立即CT扫描相比，在3个月的CT扫描中测得的HVR。次要结果是CSDH的临床复发和安全措施。

结果

46例患者被随机分配，其中41例在3个月的随访中出现（23名女性，平均年龄75.9±12.5岁）。21例患者接受了MMA栓塞术。在3个月时，ST + MMAE组的术后HVR较高（平均差异：17.5 mL； 95％置信区间：3.87至31.16 mL；P = .015）。两名参与者出现了CSDH复发（每组一名）。1例患者死亡（ST组），未报告与MMA栓塞相关的不良事件。

结论

在手术中增加中脑膜栓塞导致3个月时硬膜下慢性血肿的吸收增加。每组均报告有1例慢性硬膜下血肿复发，且无治疗相关并发症。