BackgroundThe amount of midline shift (MLS) considered safe for middle meningeal artery embolization (MMAE) in patients with chronic subdural hematoma (CSDH) has not been established. Whether MMAE could be used as upfront treatment for unilateral large CSDH patients with significant MLS (>1 cm) has not been reported.ObjectiveTo investigate the efficacy and safety of MMAE in unilateral large CSDH patients with MLS > 1 cm.MethodsEleven carefully selected CSDH patients with mild or moderate symptoms and significant MLS > 1 cm from 1 May 2021 to 31 August 2022 were included in the study. All patients were treated with MMAE using polyvinyl alcohol (PVA) particles. Outcomes were assessed clinically and with interval imaging studies at follow-up.ResultsAll 19 MMAs (unilateral embolization in three patients and bilateral embolization in eight patients) were successfully embolized. All 11 patients were followed for subsequent months, and there was no recurrence and enlargement of CSDH. Procedural adverse events, mortality, or complications were not observed. The average time to achieve a 50% reduction in MLS was approximately four weeks, while it took approximately eight weeks to achieve a 50% reduction in maximal volume. All 11 patients showed improvement in their neurological symptoms at three days post-operation, including four hemiplegic patients.ConclusionsMMAE may demonstrate safety in carefully selected CSDH patients with significant midline shift (MLS > 1 cm), particularly in those who are not suitable for surgery, thus providing a potential alternative approach.

中文翻译：

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脑膜中动脉栓塞治疗单侧大面积慢性硬膜下血肿伴明显中线移位的单中心经验

背景对于慢性硬膜下血肿（CSDH）患者脑膜中动脉栓塞（MMAE）安全的中线移位（MLS）量尚未确定。 MMAE是否可以作为MLS>1cm的单侧大型CSDH患者的前期治疗尚未见报道。目的探讨MMAE在MLS>1cm的单侧大型CSDH患者中的疗效和安全性。方法精心挑选11例CSDH患者该研究纳入了2021年5月1日至2022年8月31日期间出现轻度或中度症状且MLS显着> 1 cm的患者。所有患者均使用聚乙烯醇 (PVA) 颗粒进行 MMAE 治疗。对结果进行临床评估和随访时的间隔影像学研究。结果所有19例MMA（3名患者单侧栓塞，8名患者双侧栓塞）均成功栓塞。 11例患者均随访数月，未见CSDH复发及增大。未观察到操作不良事件、死亡率或并发症。 MLS 减少 50% 的平均时间约为 4 周，而最大体积减少 50% 则需要约 8 周。术后三天，所有 11 名患者的神经系统症状均出现改善，其中包括 4 名偏瘫患者。 结论 对于精心挑选的具有显着中线移位（MLS > 1 cm）的 CSDH 患者，尤其是那些不适合手术的患者，MMAE 可能表现出安全性，从而提供了一种潜在的替代方法。