目的 观察、分析慢性硬膜下血肿（CSDH）患者的脑膜中动脉（MMA）造影解剖，探讨其对脑膜中动脉栓塞（MMAE）手术策略的指导价值。 方法 收集2019年3月至2023年3月间期间80例CSDH患者的102支MMA造影解剖图像，由2名高年资神经介入医师独立评估，参照Adachi分型进行MMA分型，记录MMA分型、起源和变异、危险吻合、栓塞策略、手术相关并发症和术后复发。 结果 共对101支MMA（79例）进行分型，Ⅰ型44支（43.6%），分型结果一致性程度中等（Kappa=0.54，95% CI：0.39~0.69）；A型32支（31.7%），分型结果一致性程度强（Kappa=0.84，95% CI：0.72~0.96）。MMA异位起源于眼动脉（OA）1支（1.0%），OA发自MMA 2支（2.0%），MMA与OA侧支吻合5支（4.9%），与对侧MMA吻合8支（7.8%）。术后随访出现影像学复发2例。 结论 熟悉MMA造影解剖，尤其是MMA分型及可能存在的危险吻合，对指导MMAE治疗CSDH栓塞剂的选择及栓塞策略制定，提高CSDH血管内栓塞治疗效果及安全性具有重要的临床意义。
Abstract
Objective To observe and analyze the angiographic anatomy of middle meningeal artery (MMA) in patients with chronic subdural hematoma (CSDH) and explore its value of guiding MMAE strategy. Methods 102 MMA angiographic anatomic images of 80 CSDH patients from March 2019 to March 2023 were collected. Independent evaluation was performed by two senior neurointerventional physicians, MMA classification was performed by reference to Adachi classification. The MMA classification, origin and variation, dangerous anastomosis, embolization strategy, operation-related complications and postoperative recurrence were recorded. Results A total of 101 MMAs (79 cases) were classified. Type I were observed in 44/101 (43.6%) MMAs, and the results were moderately consistent (Kappa=0.54, 95% CI: 0.39-0.69). Type A were observed in 32/101 (31.7%) MMAs, and the results showed strong consistency (Kappa=0.84, 95% CI: 0.72-0.96). Out of 102 MMAs, only 1 (1.0%) MMA variously originated from the ophthalmic artery (OA). In 2 of these 102 (2.0%) MMAs, OA originated from MMA. The anastomosis with OA via collateral branch was observed in 5/102 (4.9%) MMAs and the anastomosis with the contralateral MMA branches was observed in 8/102 (7.8%) MMAs. Radiographic recurrence occurred in 2 cases during postoperative follow-up. Conclusions It is of great clinical significance to be familiar with MMA angiographic anatomy, especially the classification of MMA and the possible dangerous anastomosis, to guide the selection of embolic agents and the formulation of embolic strategies for MMAE treatment of CSDH, and to improve the efficacy and safety of endovascular embolization treatment of CSDH.
关键词
解剖学 /
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危险吻合 /
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慢性硬膜下血肿 /
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脑膜中动脉栓塞
Key words
Anatomy /
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Dangerous anastomosis /
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Chronic subdural hematoma /
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Middle meningeal artery embolization
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