概述

脑膜中动脉栓塞术 is a treatment for chronic subdural hematoma, or persistent bleeding on the surface of the brain. This nonsurgical technique removes the blood that has collected between the brain and its protective tissue layer, 硬脑膜, and generally prevents the problem from coming back.

慢性硬膜下血肿 is one of the most common neurosurgical conditions affecting older people. It can occur after an injury or medical problem that causes bleeding between the dura and the brain, 一个被称为硬膜下空间的区域.

正常情况下, 如果血液渗入硬膜下腔, the body responds by forming a thin membrane around this blood. The membrane has tiny blood vessels that allow the immune system to break down the pooled blood and remove it. But the membrane itself is also leaky; in some people, the blood leaks back out more quickly than it can be absorbed. The result is a pool of blood accumulating on the brain's surface: a chronic subdural hematoma.

此问题可能导致一系列症状, 包括头痛, 混乱, 失去平衡, 身体的一边无力. If untreated, the increasing pressure on the brain can lead to seizures, coma and even death.

The traditional treatment for chronic subdural hematoma is surgical: Two holes are drilled into the skull and a hollow tube is inserted to drain the blood. 手术可能有风险, and patients have to stay in intensive care for a few days while the hematoma is draining. 更重要的是, 1 in 4 patients has a recurrence within a month and must return to the hospital for additional treatment.

MMA embolization offers a minimally invasive, highly effective alternative. 而不是传统的手术, doctors use specialized tools that pass through blood vessels to access and block an artery supplying blood to the dura and the membrane surrounding the hematoma. 一旦它被关闭, 血液不再流入硬膜下腔, 随着时间的推移, 身体会吸收血肿.

UCSF is a national leader in endovascular procedures (minimally invasive techniques to address problems with blood vessels). 特别是, our specialists helped develop groundbreaking approaches to diagnosing and treating disorders affecting blood vessels of the brain, 颈部和脊柱.

继续阅读

谁是候选人??

MMA embolization isn't an option for everyone with a chronic subdural hematoma. 在以下情况下是合适的:

  • The patient has a chronic subdural hematoma but only mild or moderate symptoms. 而不是马上做手术, these patients have the time to undergo MMA embolization and wait for the hematoma to resolve.
  • The patient requires immediate surgery for a chronic subdural hematoma but is at risk for recurrence because of brain atrophy, 肝肾衰竭, or needing to be on blood-thinning medication for another problem. In those cases, we will perform surgery and embolization at the same time.
  • The patient had surgery to drain a chronic subdural hematoma but the problem recurred.

优势

MMA embolization offers many advantages over traditional surgery, including:

  • It can be done on an outpatient basis (patients don't have to stay overnight in the hospital), 很少或没有镇静剂.
  • It causes less discomfort and requires only one small incision.
  • 并发症的风险较低.
  • 病人恢复得很快，几乎没有停机时间.
  • It addresses the problem's root cause: the leaky membranes.
  • 血肿很少复发. This happens in only 2 to 3% of cases, compared with a 25% recurrence rate for conventional surgery.

过程

MMA embolization is performed in one of our angiogram suites, which are specially equipped for procedures that involve working through the blood vessels. Prior to the procedure, you receive a mild sedative that leaves you relaxed but awake. The endovascular neurosurgeon numbs the skin at either your wrist or groin to access the artery and inserts a catheter (a thin, 挠性管).

x射线图像引导, the surgeon threads the catheter through your blood vessels until it reaches the middle meningeal artery, 血肿附近. The surgeon then injects an agent that permanently closes off the artery; this may be a special glue, 某些种类的粒子, 或者铂微线圈. After the embolization is complete, the surgeon withdraws the catheter and closes the incision. The whole procedure typically takes 45 minutes to an hour. You should be able to go home after about two hours.

复苏

你可以立即恢复正常活动. The only issue afterward is making sure the incision site stays dry and clean as it heals.

虽然复发的可能性不大, we'll monitor your progress with follow-up CT scans at six and 12 weeks.

可能出现的并发症

风险包括出血, 感染, 中风, 疼痛和视力问题, 但这些并发症是罕见的, 只发生在1%的病人身上.