辅助中脑膜动脉栓塞用于腹膜下血液瘤
Jason M Davies1, Jared Knopman1, Maxim Mokin1
1From the Departments of Neurosurgery (J.M.D., A.H.S.), Biomedical Informatics (J.M.D.), and Radiology (A.H.S.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, the Department of Neurological Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center (J.K.), and the Department of Neurosurgery, Icahn School of Medicine at Mount Sinai (C.P.K.), New York, the Department of Neurosurgery, North Shore University Hospital at Northwell Health, Great Neck (T.W.L.), the Department of Neurosurgery, Albany Medical Center, Albany (A.R.P.), and the Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla (J. Santarelli) - all in New York; the Department of Neurosurgery and Brain Repair, University of South Florida, and Tampa General Hospital, Tampa (M.M.), Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville (R.A.H.), the Orlando Health Neuroscience Institute, Division of Neurosurgery, Orlando Health, Orlando Regional Medical Center, Orlando (M.C.C.), and the Department of Neurosurgery, University of Florida, Gainesville (M.J.K.) - all in Florida; the Department of Neuroscience, Valley Baptist Medical Center, and the Department of Neurology, University of Texas Rio Grande Valley, Harlingen (A.E.H.), the Department of Neurosurgery, Memorial Hermann-Texas Medical Center, Houston (P.R.C.), and the Department of Neurosurgery, Baylor Scott and White Health, Temple (W.S.L.) - all in Texas; the Departments of Neurosurgery and Engineering Science and Mechanics, Penn State University, Hershey (R.E.H.), the Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh (B.A.G.), and the Department of Neurosurgery, Geisinger and Geisinger Commonwealth School of Medicine, Wilkes-Barre (C.M.S.) - all in Pennsylvania; the Departments of Neurological Surgery, Surgery, Radiology, and Neurosciences, University of California, San Diego, La Jolla (A.K.), the Departments of Radiology (J.T.) and Neurosurgery (W.S.), Providence Little Company of Mary Medical Center, Torrance, Pacific Neuroscience Institute, Santa Monica (J.T., W.S.), and the Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles (W.J.M.) - all in California; the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); the Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City (R.G.); the Cerebrovascular Center, Cleveland Clinic, Cleveland (M.B.), the Department of Neurology, ProMedica Toledo Hospital-University of Toledo College of Medicine and Life Sciences, Toledo (M.J.), and Wexner Medical Center, Ohio State University, Columbus (P.Y.) - all in Ohio; the Department of Neurosurgery, Rush University, Chicago (R.W.C.), and the Department of Neurosciences, Advocate Lutheran General Hospital, Park Ridge (J.B.) - both in Illinois; the Departments of Neurological Surgery, Neurology, Radiology, Otolaryngology, and Neuroscience, University of Kentucky, Lexington (J.F.F.); the Departments of Neurological Surgery, Radiology, Neurology, and Mechanical Engineering and the Stroke and Applied Neuroscience Center, University of Washington, Seattle (M.R.L.); the Department of Neurosurgery, Atrium Health Carolinas Medical Center, and Carolina Neurosurgery and Spine Associates - both in Charlotte, NC (J.D.B.); the Department of Diagnostic Radiology and Neuroradiology, Prisma Health Southeastern Neurosurgical and Spine Institute, Greenville, SC (M.I.C.); the Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City (H.J.S.); the Departments of Neurosurgery and Radiology, University of Alabama School of Medicine, Birmingham (J.J.); the Departments of Neurosurgery, Radiology, and Neurology, Washington University in St. Louis, St. Louis (J.W.O.); the Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City (K.D.); the Department of Neurosurgery, Emory University School of Medicine, Atlanta (J.A.G.); the Department of Neurointerventional Radiology, Goodman Campbell Brain and Spine, Indianapolis (D.H.S.); the Department of Neurosurgery, Michigan State University College of Human Medicine, Grand Rapids (J.S.), the Department of Neurology, McLaren Flint Hospital, Flint (A.Q.M.), and McLaren Macomb Hospital, Mount Clemens (A.Q.M.) - all in Michigan; the Department of Neurological Surgery, Oregon Health and Science University, Portland (J.J.L.); Aurora Neuroscience Innovation Institute, Milwaukee (T.W.); the Division of Neurointerventional Radiology, Department of Radiology, Beth Israel Lahey Health, Lahey Hospital and Medical Center, Burlington, MA (N.V.P.); and the Department of Neurosurgery, University of Colorado, Denver (C.R.).
将中脑膜动脉栓塞添加到手术中,显著降低了腹膜下血瘤的重新手术率. 这种干预措施有望防止这些常见的大脑疾病在手术疏散后复发.
科学领域:
- 神经外科 神经外科
- 干预性神经辐射学
- 血管外科 血管外科
背景情况:
- 亚急性和慢性腹腔内血瘤是常见的神经疾病.
- 手术疏散后的重新手术是常见的并发症.
- 中脑膜动脉栓塞在预防复发中的作用尚未得到充分证实.
研究的目的:
- 评估中脑膜动脉栓塞与外科疏散相结合的疗效,以减少症状性脑下血液瘤的重新手术率.
- 评估这种综合方法对功能神经学结果的影响.
主要方法:
- 一个前性的,多中心的,随机的,自适应设计的试验.
- 患有症状的亚急性或慢性亚硬性血瘤的患者被分配到中脑膜动脉栓塞加手术或单独手术中.
- 主要终点是血液瘤复发或进展,需要在90天内重复手术.
主要成果:
- 与对照组 (11.3%) 相比,治疗组 (4.1%) 的血液瘤复发或进展率导致重新手术的比例明显较低.
- 在90天后,两组之间没有观察到功能恶化的显著差异.
- 与栓塞相关的严重不良事件发生在治疗组的2.0%的患者中.
结论:
- 中脑膜动脉栓塞加上手术与症状性脑下血液瘤的重新手术风险降低有关.
- 进一步的研究是有必要的,以充分了解中脑膜动脉栓塞的安全概况在这种情况下.


