脑膜中动脉栓塞治疗后慢性硬膜下血肿的吸收时间及其影响因素研究

Time interval from middle meningeal artery embolization to resolution of chronic subdural hematoma and its influencing factors

目的探讨脑膜中动脉栓塞(MMAE)治疗后慢性硬膜下血肿(CSDH)的吸收时间及其影响因素。方法回顾性分析2019年5月至2021年5月扬州大学附属医院介入放射科单纯采用MMAE或MMAE联合钻孔引流术治疗的41例(53例侧)CSDH患者的临床资料。记录患者人口统计学数据、可能影响血肿吸收或复发的术前合并症、是否抗栓治疗、术前血肿的影像学特征、术中Dyna CT血肿外膜强化分级及术后血肿吸收情况;对于双侧病变者,按照血肿量较大侧统计血肿情况。根据术后4个月内血肿是否完全吸收,将患者分为完全吸收组与未完全吸收组。进行单因素和多因素logistic回归分析,以判断影响CSDH吸收的因素。结果41例患者共进行53例侧CSDH手术,其中联合钻孔引流术治疗22例。术后残余血肿的最大径为(13.5±3.6)mm(10.8~21.5 mm)。1例(2.4%)患者MMAE术后血肿复发。所有CSDH患者均未见MMAE手术相关并发症。41例患者的随访时间为(17.2±6.1)周,末次随访时血肿完全吸收40例(97.6%),其中4个月内完全吸收27例(65.9%),6个月完全吸收39例(95.1%),CSDH的中位吸收时间为14(12,20)周。单因素logistic回归分析结果显示,与完全吸收组(27例)比较,未完全吸收组(14例)的年龄大、MMAE术后抗栓治疗者占比高、残余血肿的最大径较大、术中Dyna CT血肿外膜强化分级Ⅰ级者占比高、联合钻孔引流术治疗者占比低(均P<0.05)。多因素logistic回归分析结果显示,残余血肿的最大径(OR=0.63,95%CI:0.31~0.92,P=0.012)、术中Dyna CT血肿外膜强化分级Ⅰ级(OR=0.48,95%CI:0.25~0.81,P=0.027)及是否联合钻孔引流术(OR=3.13,95%CI:0.37~0.89,P=0.026)是4个月内血肿能否完全吸收的独立影响因素。结论CSDH多于MMAE术后4个月内完全吸收。MMAE术后残余血肿的最大径较大、术中Dyna CT血肿外膜强化分级Ⅰ级及未联合钻孔引流术的患者,4个月时血肿未完全吸收的风险高。

Objective To investigate the resolution time of chronic subdural hematoma(CSDH)after middle meningeal artery embolization(MMAE)and its influencing factors.Methods A retrospective analysis was performed on the clinical data of 41(53 lesions)CSDH patients treated with MMAE or MMAE combined with burr hole drainage in the Department of Interventional Radiology,the Affiliated Hospital of Yangzhou University from May 2019 to May 2021.The patients′demographic data,preoperative comorbidities that may affect hematoma absorption or recurrence,whether antithrombotic therapy was administered,preoperative imaging characteristics of hematoma,intraoperative Dyna CT hematoma membrane enhancement grade and postoperative hematoma absorption were documented.For patients with bilateral lesions,hematoma conditions were assessed based on the larger hematoma.Patients were divided into complete absorption group and incomplete absorption group according to whether the hematoma was completely absorbed 4 months after surgery.Univariate and multivariate logistic regression analyses were performed to determine the influencing factors of CSDH absorption.Results A total of 53 surgical procedure for CSDH lesions were performed in 41 patients,out of whom 22 patients underwent MMAE combined with burr hole drainage.The maximum diameter of postoperative residual hematoma was 13.5±3.6 mm(10.8-21.5mm).Hematoma recurrence after MMAE was reported in 1 case(2.4%).No MMAE-related complications were observed in this series.All 41 patients were followed up for 17.2±6.1 weeks.The hematoma was completely absorbed in 40 cases(97.6%)at the latest follow-up,in 27 cases(65.9%)at 4-month follow-up and in 39 cases(95.1%)at 6-month follow-up.The median absorption time of CSDH was 14(12,20)weeks.Univariate logistic regression analysis showed that compared with complete absorption group(27 cases),the patients were older,proportion of antithrombotic treatment after MMAE was higher,maximum diameter of residual hematoma was larger,proportion of intraoperative Dyna CT hematoma membrane enhancement gradeⅠwas higher,proportion of patients undergoing MMAE combined with burr hole drainage was lower in the incomplete absorption group(14 cases)(all P<0.05).Multivariate logistic regression analysis showed that the maximum diameter of residual hematoma(OR=0.63,95%CI:0.31-0.92,P=0.012),the intraoperative Dyna CT hematoma membrane enhancement gradeⅠ(OR=0.48,95%CI:0.25-0.81,P=0.027)and whether combined burr hole drainage were performed(OR=3.13,95%CI:0.37-0.89,P=0.026)were independent factors for complete absorption of hematoma at 4-month follow-up.Conclusions After MMAE treatment,CSDH can usually be absorbed within 4 months.Incomplete absorption of CSDH hematoma at 4-month follow-up may be associated with the large maximum diameter of residual hematoma after MMAE,intraoperative CT hematoma membrane enhancement gradeⅠand treatment without combined burr hole drainage.