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中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2021, Vol. 09 ›› Issue (04) : 376 -382. doi: 10.3877/cma.j.issn.2095-5782.2021.04.005

神经介入

脑膜中动脉栓塞联合硬通道穿刺治疗慢性硬膜下血肿初探
张浩宇1, 宋英伦1, 杨洪超1, 贾建文1, 钟红亮1, 李雄1, 李彤1, 汪阳1, 刘赫1,†()   
  1. 1. 100020　北京，首都医科大学附属北京朝阳医院神经外科
  • 收稿日期:2021-06-19 出版日期:2021-11-25
  • 通信作者: 刘赫

Treatment of middle meningeal artery embolization combined with hematoma drainage on chronic subdural hematoma: a preliminary study

Haoyu Zhang1, Yinglun Song1, Hongchao Yang1, Jianwen Jia1, Hongliang Zhong1, Xiong Li1, Tong Li1, Yang Wang1, He Liu1,†()   

  1. 1. Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
  • Received:2021-06-19 Published:2021-11-25
  • Corresponding author: He Liu
  • About author:
    Co-first aughors: Zhang Haoyu, Song Yinglun
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张浩宇, 宋英伦, 杨洪超, 贾建文, 钟红亮, 李雄, 李彤, 汪阳, 刘赫. 脑膜中动脉栓塞联合硬通道穿刺治疗慢性硬膜下血肿初探[J]. 中华介入放射学电子杂志, 2021, 09(04): 376-382.

Haoyu Zhang, Yinglun Song, Hongchao Yang, Jianwen Jia, Hongliang Zhong, Xiong Li, Tong Li, Yang Wang, He Liu. Treatment of middle meningeal artery embolization combined with hematoma drainage on chronic subdural hematoma: a preliminary study[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2021, 09(04): 376-382.

目的

旨在初步探究脑膜中动脉（MMA）栓塞联合硬通道穿刺治疗慢性硬膜下血肿（CSDH）的安全性及有效性。

方法

收集2019年7月至2021年2月间于首都医科大学附属北京朝阳医院接受手术治疗的40例CSDH患者。其中35例接受单纯硬通道穿刺引流术治疗；5例接受MMA栓塞治疗，必要时联合硬通道穿刺。通过微导管超选进入脑膜中动脉，利用Onyx胶选择性栓塞脑膜中动脉的责任分支，对血肿较厚及中线移位的患者立即进行硬通道血肿穿刺引流术。术后对患者进行随访，观察血肿吸收、复发情况及是否出现相关并发症。

结果

全部40例CSDH患者手术成功率100%，所有患者血肿清除良好，无手术相关并发症。35例接受单纯硬通道穿刺引流，平均随访时间（8.1 ± 3.7）周，2例（5.7%）复发。5例慢性硬膜下血肿患者共进行了7次脑膜中动脉栓塞治疗。其中原发患者4例，复发患者1例；栓塞联合引流4例，单纯栓塞1例；单侧栓塞3例，双侧栓塞2例，中位随访时间（19.0 ± 7.0）周，随访期间均未发现复发。

结论

初步证实脑膜中动脉栓塞联合硬通道穿刺治疗慢性硬膜下血肿安全、有效，远期疗效值得期待。

关键词: 慢性硬膜下血肿, 栓塞, 脑膜中动脉, 介入治疗
Objective

To evaluate the safty and effect of the treatment of middle meningeal artery (MMA) embolization combined with hematoma drainage on chronic subdural hematoma (CSDH).

Methods

From July 2019 to Feburary 2021, forty CSDH patients received surgical treatment in Beijing Chaoyang Hospital, Capital Medical University. Thirty five of them recived hematoma drainage. Five patients recieved MMA embolization, and if necessary, extra hematoma drainage. Selective branches of MMA embolizations was performed by Onyx. After embolization, the hematoma drainage was perfomed immediately if obvious mass effect or midline shift was confirmed on computer tomography (CT) scan. Hematoma volume resorption, recurrence and complications associated with treatment was observed during follow up.

Results

One hundred persent of the operations were successful. Hematoma volume reduced in all the patients and no recurrence and complication that related to the treatment was seen during the follow up. Thirty-five patients received hematoma drainage. The average follow up time was (8.1 ± 3.7) weeks, two recurrences (5.7%) were seen during follow up. Five CSDH patients received a total of 7 MMA embolizations. Four of the 5 patients were primary CSDH, one of the 5 patients was recurrent. A total of 3 patients underwent unilateral interventions and 2 of them underwent bilateral interventions. The median follow up time was (19.0 ± 7.0) weeks.

Conclusions

Method of MMA embolization combined with hematoma drainage was safe and effective in treating CSDH, and futher result to be expected.

Key words: CSDH, Embolization, MMA, Interventional therapy
表1 接受脑膜中动脉栓塞患者的病例特点
病例编号 1 2 3 4 5
年龄/性别 63/女 83/男 91/男 78/男 52/男
外伤史 否 是 是 是 否
术前症状 右侧肢体无力 头痛 无明显症状 右下肢无力 左下肢无力
主要伴随疾病 椎动脉瘤栓塞术后、糖尿病 高血压 高血压、心脏起搏器植入、陈旧脑梗死 高血压、糖尿病、动脉支架植入、肺癌术后 糖尿病
术前抗凝或抗血小板药物使用 否 否 否 阿司匹林 否
原发/复发 原发 复发 原发 原发 原发
血肿侧别 左侧 右侧 双侧 左侧 右侧
血肿最大厚度（mm） 23.6 14.1 30.6 22.6 17.0
中线移位（mm） 13.3 0 4.0 5.4 5.0
MMA栓塞 左侧 双侧 双侧 左侧 右侧
栓塞MMA分支 额支及顶支 额支 额支 额支及顶支 额支
术后症状 改善 改善 改善 改善 改善
术后并发症 无 无 无 无 无
随访时间（周） 21 19 19 12 4
是否复发 否 否 否 否 否
图1 病例1，左侧额颞顶CSDH，术中及术后的头CT平扫1A：术前CT显示左侧额颞顶慢性硬膜下血肿；1B：术后出院时CT提示血肿清除满意；1C：术后2个月复查头部CT提示患者左额颞部慢性硬膜下血肿几乎完全吸收。
图2 病例1，术中造影确认左MMA额支为CSDH相关供血动脉，并实施栓塞术2A：栓塞手术前颈外动脉造影MMA显影良好；2B：缓慢注入Onyx胶，使其弥散至MMA远端；2C：栓塞完成后颈外动脉造影，MMA不显影。图中黑色尖头所示为MMA。
图3 病例2，双侧慢性硬膜下血肿穿刺术后5周复发，术前术后影像学检查3A：头部CT提示为双侧硬膜下血肿；3B：行双侧硬膜下血肿硬通道穿刺引流术，术后头部CT提示双侧血肿清除满意；3C：5周后复查头部MRI提示右侧慢性硬膜下血肿复发；3D：行双侧MMA栓塞，栓塞术后1个月复查头部MRI，右侧硬膜下血肿提及明显缩小。
图4 病例2，双侧慢性硬下血肿穿刺术后5周复发，术中情况4A：栓塞前选择性MMA造影可见MMA显影良好；4B：通过微导管缓慢注入Onyx胶，使其逐渐弥散至MMA远端；4C：栓塞完毕后颈外动脉造影未见MMA显影，栓塞手术成功。
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