复发性慢性硬膜下血肿脑膜中动脉影像学特征及介入栓塞治疗
Radiological characteristics of the middle meningeal artery in recurrent chronic subdural hematoma and its embolization therapy
刘振生 1魏庭丰 1孙勇 1匡雄伟 1王友伟 2吴臣义 2段晓春 2齐文涛 2彭爱军 2张文3
作者信息
- 1. 225001 江苏扬州 扬州大学附属医院介入放射科
- 2. 225001 江苏扬州 扬州大学附属医院神经外科
- 3. 225001 江苏扬州 扬州大学附属医院超声科
- 折叠
摘要
目的 初步评估复发性慢性硬膜下血肿(chronic subdural hematoma,CSDH)脑膜中动脉形态学和血流动力学特征,及脑膜中动脉栓塞(middle meningeal artery embolization,MMAE)治疗疗效.方法 回顾性分析我院2019年5月至2022年12月期间31例(15.2％)外科钻孔引流术后复发并接受MMAE治疗的20例单侧CSDH患者的临床及影像资料.于3D-TOF MRA测量患侧MMA直径、相对血流速度,并与随机抽取同期外科钻孔引流术后未复发的20例CSDH患者作为对照.随访观察MMAE术后影像学结果、临床症状改善及并发症等.结果 复发组患侧MMA平均直径(1.55±0.45)mm明显大于对照组(1.32±0.36)mm,两组差异有统计学意义(t=2.118,P=0.028).复发组相对血流速度(SI比值均数,1.45±0.23)明显大于对照组(SI比值均数,1.23±0.26),两组差异有统计学意义(t=3.493,P=0.001).复发组血肿外膜强化分级评分(2.25±0.55)分,对照组(1.60±0.68)分,两组差异有统计学意义(t=3.322,P=0.002).MMAE术后影像学随访血肿完全吸收19例(95％),其中3个月完全吸收8例(40％),6个月完全吸收16例(95％),中位吸收时间16周(IQR:7～22).除1例复发症状反复外,余患者临床症状均不同程度改善,所有患者均未见手术相关并发症.结论 与非复发者相比,外科术后复发侧血肿外膜血供更丰富、MMA管径更粗、血流速度更快,MMAE是治疗此类CSDH安全有效的方法.
Abstract
Objective To discuss the morphological and hemodynamic characteristics of the middle meningeal artery(MMA)in recurrent chronic subdural hematoma(CSDH),and to evaluate the therapeutic efficacy of middle meningeal artery embolization(MMAE)for CSDH.Methods The clinical data and imaging materials of 31 patients with recurrent CSDH after surgical drilling and drainage,who were admitted to the Affiliated Hospital of Yangzhou University of China to receive MMAE between May 2019 and December 2022,were retrospectively analyzed.The diameter and relative blood flow velocity of the affected MMA were measured by using 3D-TOF MRA,which were compared with those in 20 randomly selected patients with CSDH who did not recur after surgical operation at the same period.The imaging follow-up was adopted after MMAE,and the improvement of clinical symptoms and the incidence of complications were analyzed.Results The mean diameter of MMA on the affected side in the recurrent group was(1.55±0.45)mm,which was significantly larger than(1.32±0.36)mm in the control group,the difference was statistically significant(t=2.118,P=0.028).The relative blood flow velocity in the recurrent group was(1.45±0.23),which was remarkably higher than(1.23±0.26)in the control group,the difference between the two groups was statistically significant(t=3.493,P=0.001).The mean hematoma membrane enhancement grading score in the recurrent group was(2.25±0.55)points,which in the control group was(1.60±0.68)points,the difference between the two groups was statistically significant(t=3.322,P=0.002).After MMAE,imaging follow-up examination showed that complete absorption of hematoma was seen in 19 patients(95％),among them,complete absorption of hematoma within 3 months after MMAE was seen in 8 patients(40％),within 6 months after MMAE was seen in 16 patients(95％),and the median time of complete absorption of hematoma was 16 weeks(IQR:7-22).In all patients,except one patient who developed recurrent symptoms,the clinical symptoms were improved to varying degrees,and no MMAE-related complications were observed.Conclusion Compared with non-recurrent patients,in the recurrent patients the blood supply of hematoma membrane becomes richer,the MMA diameter becomes larger,the blood flow velocity becomes faster at the recurrent side.MMAE is a clinically safe and effective method for the treatment of such CSDH.(J Intervent Radiol,2024,33:413-418)
关键词
慢性硬膜下血肿/复发/脑膜中动脉/血管造影/栓塞Key words
chronic subdural hematoma/recurrence/middle meningeal artery/angiography/embolization引用本文复制引用
出版年
2024
NETL
NSTL
万方数据