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.
Key words
Anatomy /
/
/
Dangerous anastomosis /
/
/
Chronic subdural hematoma /
/
/
Middle meningeal artery embolization
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Adhiyaman V, Chattopadhyay I, Irshad F, et al. Increasing incidence of chronic subdural haematoma in the elderly[J]. QJM, 2017,110(6):375-378. DOI: 10.1093/qjmed/hcx143.
[2] Abecassis IJ, Kim LJ. Craniotomy for Treatment of Chronic Subdural Hematoma[J]. Neurosurg Clin N Am, 2017,28(2):229-237. DOI: 10.1016/j.nec.2016.11.005.
[3] Ban SP, Hwang G, Byoun HS, et al. Middle Meningeal Artery Embolization for Chronic Subdural Hematoma[J]. Radiology, 2018, 286(3):992-999. DOI: 10.1148/radiol.2017170053.
[4] 刘振生, 曹德茂, 孙勇, 等. 脑膜中动脉栓塞与传统方法治疗慢性硬膜下血肿疗效的倾向性评分匹配对比研究[J]. 中华放射学杂志, 2022,56(6):661-666. DOI: 10.3760/cma.j.cn112149-20210917-00859.
[5] Bruner E, Mantini S, Ripani M. Landmark-based analysis of the morphological relationship between endocranial shape and traces of the middle meningeal vessels[J]. Anat Rec (Hoboken), 2009,292(4):518-527. DOI: 10.1002/ar.20868.
[6] 虞昊, 张毅, 金国华, 等. 颅眶孔和眶外侧沟的应用解剖学研究[J]. 中国临床解剖学杂志, 2011, 29(5):485-488. DOI: 10.13418/j.issn.1001-165x.2011.05.003.
[7] Pouvelle A, Pouliquen G, Premat K, et al. Larger middle meningeal arteries on computed tomography angiography in patients with chronic subdural hematomas as compared with matched controls[J]. J Neurotrauma, 2020,37(24):2703-2708. DOI: 10.1089/neu.2020.7168.
[8] 刘振生, 王鸿生, 孙勇, 等. 脑膜中动脉栓塞治疗慢性硬膜下血肿影像解剖学依据研究[J]. 临床放射学杂志, 2021,40(11):2188-2192.
[9] Catapano JS, Ducruet AF, Nguyen CL, et al. Middle meningeal artery embolization for chronic subdural hematoma: an institutional technical analysis[J]. J Neurointerv Surg, 2021,13(7):657-660. DOI: 10.1136/neurintsurg-2020-016552.
[10]El-Khouly H, Fernandez-Miranda J, Rhoton A J. Blood supply of the facial nerve in the middle fossa: the petrosal artery[J]. Neurosurgery, 2008,62(5 Suppl 2):S297-S303, S303-S304. DOI: 10.1227/01.neu.0000326010.53821.a3.
[11]Ferber A, Zhou Y, Greenwald B. Persistent facial nerve palsy after middle meningeal artery embolization for subdural hematoma: a case report[J]. Brain Inj, 2023,37(5):457-460. DOI: 10.1080/02699052.2023.2166116.
[12]Fantoni M, Eliezer M, Serrano F, et al. High frequency of ophthalmic origin of the middle meningeal artery in chronic subdural hematoma[J]. Neuroradiology, 2020,62(5):639-644. DOI: 10.1007/s00234-020-02363-6.
[13]Hubbard ZS, Al KS, Porto GB, et al. Chronic subdural hematoma recurrence due to contralateral neovascularization following middle meningeal artery embolization[J]. Interv Neuroradiol, 2022,28(6):639-643. DOI: 10.1177/15910199211065197.
[14]Shehabeldin M, Amllay A, Jabre R, et al. Onyx Versus Particles for Middle Meningeal Artery Embolization in Chronic Subdural Hematoma[J]. Neurosurgery, 2023, 92(5):979-985. DOI: 10.1227/neu.0000000000002307.
[15]Khorasanizadeh M, Shutran M, Garcia A, et al. Middle Meningeal Artery Embolization with Isolated Use of Coils for Treatment of Chronic Subdural Hematomas: A Case Series[J]. World Neurosurg, 2022,165:e581-e587. DOI: 10.1016/j.wneu.2022.06.099.
[16]Samarage HM, Kim WJ, Zarrin D, et al. The "Bright Falx" Sign-Midline Embolic Penetration Is Associated With Faster Resolution of Chronic Subdural Hematoma After Middle Meningeal Artery Embolization: A Case Series[J]. Neurosurgery, 2022,91(3):389-398. DOI: 10.1227/neu.0000000000002038.
[17]Ku JC, Dmytriw AA, Essibayi MA, et al. Embolic Agent Choice in Middle Meningeal Artery Embolization as Primary or Adjunct Treatment for Chronic Subdural Hematoma: A Systematic Review and Meta-analysis[J]. AJNR Am J Neuroradiol, 2023,44(3):297-302. DOI: 10.3174/ajnr.A7796.
PDF(4524 KB)
