脑膜中动脉栓塞治疗急性外伤性硬脑膜外血肿的疗效分析

目的 观察脑膜中动脉(MMA)栓塞治疗急性外伤性硬脑膜外血肿(ATEDH)的有效性和安全性.方法 回顾性分析2010年1月至2020年1月在海军军医大学(第二军医大学)长海医院脑血管病中心接受MMA栓塞治疗的40例ATEDH患者资料.患者于发病24 h内行局部麻醉下数字减影血管造影(DSA)+MMA栓塞术,介入栓塞术后根据患者意识状态、血肿体积予药物保守治疗、钻孔引流术或开颅血肿清除术.随访至术后6个月,观察患者术后病情、血肿吸收情况及并发症发生情况.结果 40例ATEDH患者中男21例、女19例,年龄为16～68岁,入院时格拉斯哥昏迷量表(GCS)评分为13～15分者25例,9～12分者15例.40例患者脑血管造影均显示MMA为出血源,均在介入栓塞术后出血立即停止.8例患者采用单纯MMA栓塞治疗,32例MMA栓塞后行钻孔引流术,无患者因病情进展接受开颅血肿清除术.出院时40例ATEDH患者的GCS评分均为15分,头痛、恶心、呕吐等临床症状与入院时相比均明显好转.术后6个月复查时,40例患者均未见血肿进展或复发,扩展的格拉斯哥结局量表评分均为8分.随访过程中,所有患者均未发生手术相关的感染、缺血性脑卒中、神经功能障碍等并发症.结论 MMA栓塞可以有效控制ATEDH进展,减少再出血风险,能有效避免患者进一步接受创伤较大的外科侵入性干预.

Middle meningeal artery embolization in treating acute traumatic epidural hematoma: an analysis of efcacy

Aim: To evaluate the efficacy and safety of middle meningeal artery embolization in dealing with acute traumatic epidural hematoma. Methods: Forty cases of acute traumatic epidural hematoma who received neurosurgical treatment from January 2010 to January 2020 were retrospectively analyzed. These patients received cerebral angiography under local anesthesia within 24 hours after on set. Middle meningeal artery embolization was performed after meningeal artery was confirmed to be the relevant vessel. Borehole drainage was performed according to the consciousness and the volume of hematoma after the embolization. The volumes of hematomas before and 6 months after the operation were measured. The Glasgow coma scores with prognostic scores were acquired before the operation, before discharge, and 6 months after the operation. Results: The bleeding was immediately stabilized after endovascular embolization. Simple embolization was performed in 8 cases, and embolization combining with borehole drainage was performed in 32 cases. Conclusion: Middle meningeal artery embolization effectively limited the progression of acute traumatic epidural hematoma and reduced the risk of recurrent hemorrhage, which reduced the requirement of further invasive operations.