弹簧圈栓塞脑膜中动脉治疗复发性慢性硬脑膜下血肿疗效分析OA

Objective To investigate the safety and efficacy of middle meningeal artery embolization(MMAE)using coils alone for the treatment of recurrent chronic subdural hematoma(CSDH).Methods A retrospective,consecutive analysis was performed on patients with recurrent CSDH after burr hole drainage who were treated with coil-only MMAE at the Brain Center of the Eighth People's Hospital of Qingdao between January 2021 and January 2025.Patient demographic and clinical data were collected,including sex,age,clinical manifestations,preoperative modified Rankin scale(mRS)score,side of hematoma(left-sided,right-sided or bilateral),and hematoma volume.All patients were initiated on oral atorvastatin calcium tablets(40 mg per dose,once nightly)upon admission.All underwent bilateral MMAE,with technical success defined as the absence of blood flow through the frontal and parietal branches of the middle meningeal artery on intraoperative angiography.Intraoperative observation was conducted for ectopic embolization.Within 3 days postoperatively,patients were monitored for body temperature,muscle strength,and other clinical indicators,and head CT was performed to evaluate perioperative complications such as intracranial infection,new cerebral infarction,or new intracranial hemorrhage.Follow-up was conducted via outpatient visit or telephone at 1,3,and 6 months postoperatively to assess improvement in clinical symptoms,occurrence of new neurological deficits,neurological status via mRS,and head CT to evaluate changes in hematoma volume and recurrence(defined as an increase in hematoma volume on CT compared to the previous scan).Validity indexes included improvement in clinical symptom at 6-month postoperatively,decrease in mRS score≥1,decrease in hematoma volume≥50％and no recurrence in comparison with preoperatively.Safety index included perioperative complication rate<5.3％.Results A total of 21patients with recurrent CSDH after burr hole drainage were enrolled,including 15males and 6 females,aged 56 to 85 years,with a median age of 71(66,75)years.There were 14cases of unilateral hematoma(9 left-sided,5 right-sided)and 7 cases of bilateral hematoma.A total of 17 patients presented with clinical symptoms such as headache,dizziness,weakness,or unsteady gait,while 3 patients manifested symptoms including slurred speech,drowsiness,or increased sleep,1 patient presented with urinary incontinence.All 21 patients achieved complete bilateral MMAE,with no intraoperative or perioperative complications.At 6 months postoperatively,all patients showed significant improvement in hematoma-related symptoms,and their mRS scores decreased by≥1 point compared to preoperative scores.By 6 months postoperatively,complete hematoma absorption was observed in 8 patients,absorption of 90％to 99％in 10 patients,absorption of 80％to 89％in 2 patients,and absorption of 70％to 79％in 1 patient.No recurrence was observed in any patient at the 6-month follow-up.10 patients were followed up for more than 12 months postoperatively,including 2 patients followed up for 2 years and 3 months,with no recurrence reported during the follow-up period.Conclusions Sole application of coils for MMAE is an effective method for treating recurrent CSDH,with a low complication rate,though its long-term efficacy requires further observation.The findings of this study await further validation by large-scale,prospective studies.