慢性硬膜下血腫に対する初回治療：ドレナージ術と中硬膜動脈塞栓術との比較

抄録

Background: The purpose of this study was to clarify the criteria for initial treatment of chronic subdural hematoma (CSDH) by com­paring the backgrounds and post–treatment courses of patients who underwent drainage or middle meningeal artery (MMA) emboliza­tion for CSDH.

Methods: We performed a retrospective investigation of 23 and 21 patients who underwent drainage and MMA embolization, respec­tive­ly, performed between April 2020 and July 2022 as initial treatment for unilateral CSDH.

Results: There was no significant difference between the drainage and embolization groups in terms of age (78 vs 76 years), gender, lateral­ity of lesion, maximum diameter of hematoma (21 vs 19 mm), pretreatment Markwalder grading system (MGS) score (1 vs 1), or length of hospital stay (5 vs 17 days) between the groups. Pretreatment midline shift was greater in the drainage group than the MMA embolization group (8.8 vs 6.6 mm). Operative time was shorter in the drainage group (32 vs 79 min). Recurrence occurred in 2/23 (8.7%) of the drain­age group, in whom addi­tional MMA embo­lization was per­formed. Additional drainage was required due to exacerbation of symptoms in 4/21 (19%) of the MMA embo­lization group. No perioperative complications occurred in either group. There was no significant difference in median pre­operative MGS score (1 vs 1) or mean maximum hematoma diameter (18 vs 19 mm) in the 17 patients who showed resolution of CSDH by MMA embolization alone or in the 4 patients who required additional drain­age. Mean midline deviation was 6.1 and 8.9 mm in the embo­lization alone and additional drainage groups, respec­tively, and was significantly greater in those who required additional drainage (p=0.002).

Conclusions: The postoperative course between patients who under­went drainage or embolization for CSDH showed no significant difference in the case of very mild preoperative neurological findings (MGS score of about 1). Patient selection for MMA embolization as the initial treatment for CSDH should be clarified based on clinical symptoms and the radiological findings.