医学
栓塞
脑膜中动脉
放射科
血肿
外科
大脑中动脉
慢性硬膜下血肿
内科学
缺血
作者
Hasitha Milan Samarage,Wi Jin Kim,David A. Zarrin,Keshav Goel,Anthony Chin-Hsiu Wang,Jeremiah N. Johnson,Naoki Kaneko,May Nour,Viktor Szeder,Satoshi Tateshima,Reza Jahan,Gary Duckwiler,Geoffrey P. Colby
出处
期刊:Neurosurgery
[Oxford University Press]
日期:2022-05-17
卷期号:91 (3): 389-398
被引量:7
标识
DOI:10.1227/neu.0000000000002038
摘要
BACKGROUND: Chronic subdural hematomas (CSDHs) are common in the elderly population and patients taking antiplatelet/anticoagulation medications. Middle meningeal artery (MMA) embolization has become an adjunctive treatment to observation and surgery. Despite many embolization techniques, best practices for optimal CSDH resolution remain unknown. OBJECTIVE: To report a retrospective case series of MMA embolization for CSDHs regarding rate of hematoma improvement and the significance of distal embolic penetration into the falx. METHODS: Retrospective chart review was performed on all patients who underwent MMA embolization for CSDHs between January 2017 and June 2021. Patient demographics, clinical presentation, anticoagulant use, and radiographic features were collected. Pre-embolization and postembolization computed tomography scans were analyzed for volumetric changes and assessed for midline penetration of embolic material in the falx. RESULTS: MMA embolization was performed in 37 patients and 53 hemispheres. Older patients took longer to obtain complete resolution of CSDHs (r = 0.47, P = .03). Patients with larger pre-embolization (r = 0.57, P = .007) and postembolization (r = 0.56, P = .008) CSDH volumes took longer to completely resolve. Patients who had n-butyl cyanoacrylate embolization with midline penetration, as evidenced by the “bright falx” sign, had faster improvement rates than those who did not (5.64 cm 3 /d vs 1.2 cm 3 /d, P = .02). CONCLUSION: Distal penetration of embolic material, particularly n-butyl cyanoacrylate, into the falx may lead to more rapid improvement of CSDH.
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