Sequential Middle Meningeal Artery Embolization after Burr Hole Surgery for Recurrent Chronic Subdural Hematoma
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- DOFUKU Shogo
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center
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- SATO Daisuke
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center
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- NAKAMURA Rika
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center
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- OGAWA Shotaro
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center
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- TORAZAWA Seiei
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center
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- SATO Masayuki
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center
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- OTA Takahiro
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center
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説明
<p>Middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) is a novel, minimally invasive treatment. The indications and treatment practices for MMAE are variable and remain controversial. This study aimed to evaluate a strategy involving sequential MMAE after burr hole surgery for treating recurrent CSDH. We performed a retrospective analysis of data from consecutive patients who had undergone MMAE using liquid embolic agents within approximately 2 weeks after burr hole surgery for recurrent CSDH from September 2020 to March 2022. We analyzed patient characteristics, procedural details, CSDH recurrence after MMAE, surgical rescue, and complications. Six of the nine patients who underwent MMAE for CSDH recurrence were male, and the median age was 85 (range, 70-94) years. Five of the nine patients were being administered antithrombotic agents. The median duration between the burr hole surgery and MMAE procedure was 10 (range, 3-25) days. Anterior and posterior convexity branches were targeted for embolization using low-concentration N-butyl cyanoacrylate (NBCA), and the abnormal vascular networks with a cotton wool appearance disappeared after embolization in all cases. The NBCA distribution was observed by high-resolution computed tomography during the procedure; in three of nine cases, the NBCA penetrated not only the MMA but also the inner membrane. No recurrence, surgical rescue, or complications were observed in any patient during the median follow-up period of 3 months. As a minimally invasive treatment for recurrent CSDH, sequential MMAE after burr hole surgery may be a safe and effective option for preventing recurrence.</p>
収録刊行物
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- Neurologia medico-chirurgica
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Neurologia medico-chirurgica 63 (1), 17-22, 2023-01-15
一般社団法人 日本脳神経外科学会
