Observation on the therapeutic effect and influencing factors of selective ligation of the middle meningeal artery after drilling and drainage surgery for chronic subdural hematoma
10.3760/cma.j.cn115455-20240116-00075
- VernacularTitle:选择性脑膜中动脉结扎在慢性硬脑膜下血肿钻孔引流术后疗效观察及影响因素分析
- Author:
Yuliang FAN
1
;
Bin WU
;
Chunlei ZHU
;
Xiaolin ZHAO
;
Yi ZHAO
;
Huan LIU
Author Information
1. 北京老年医院神经外科，北京 100094
- Keywords:
Hematoma, subdural, chronic;
Ligation of the middle meningeal artery;
Investigate the efficacy;
Influence factor
- From:
Chinese Journal of Postgraduates of Medicine
2024;47(9):835-839
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy and influencing factors of selective ligation of the middle meningeal artery after drilling and drainage surgery for chronic subdural hematoma.Methods:The clinical data of patients with chronic subdural hemorrhage who underwent routine drilling and drainage surgery in Beijing Geriatric Hospital from October 2018 to January 2021 were taken as the control group; The clinical data of patients with chronic subdural hemorrhage who underwent routine drilling and drainage surgery and ligation of the middle meningeal artery in the same hospital from February 2021 to January 2023 was taken as the observation group.Results:Comparison of CSDH Markwalder grading scale and Glasgow coma scale (MGS-GCS) neurosurgical dysfunction grading before and after surgery between the control group and the observation group showed statistically significant differences ( χ2 = 34.56 and 63.39, P<0.01). There was statistically significant difference in the grading of postoperative MGS-GCS neurosurgical dysfunction between the control group and the observation group ( χ2 = 4.34, P = 0.037); the recurrence rate of the observation group was lower than that of the control group: 10.6% (5/47) vs. 28.0% (14/50), with statistical differences ( χ2 = 4.63, P = 0.031). The factors that reduce recurrence in the middle meningeal artery ligation group included Alzheimer disease coronary heart disease, males, oral antipsychotic and oral anticoagulant ( χ2 = 15.25, 4.36, 6.09, 12.63 and 8.68; P<0.05). Conclusions:Preliminary exploration has found that selective ligation of the middle meningeal artery during the drilling and drainage surgery for chronic subdural hematoma can reduce postoperative recurrence, especially suitable for patients with Alzheimer disease, coronary heart disease, males, oral antipsychotic and oral anticoagulant. After preoperative CT skull reconstruction and pruning to obtain the sulcus of the middle meningeal artery, the body surface localization of the ligation of the middle meningeal artery can be obtained. This surgery is safe and there is no additional damage to the cranial nerve. The efficacy of this surgical technique is expected to be further validated through large-scale, multicenter, randomized controlled studies.
