Middle meningeal artery embolization using cone-beam computed tomography augmented guidance in patients with cancer.
Middle meningeal artery embolization using cone-beam computed tomography augmented guidance in patients with cancer.
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DOI：
10.1016/j.diii.2023.03.007
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发表时间：
2023-03
影响因子：
5.5
通讯作者：
Omar Dzaye;A. Brahmbhatt;Aaron C. Abajian;A. Moussa;K. Yu;N. Moss;W. Newman;E. Lis;V. Tabar;Francois H. Cornelis
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作者：
Omar Dzaye;A. Brahmbhatt;Aaron C. Abajian;A. Moussa;K. Yu;N. Moss;W. Newman;E. Lis;V. Tabar;Francois H. Cornelis
目的本研究的目的是评估在锥形束计算机断层扫描 (CBCT) 增强引导下对癌症患者进行脑膜中动脉栓塞术 (MMAE) 的安全性和有效性。 材料和方法 11 名癌症患者（7 名女性，4 名男性；中位年龄 75 岁；年龄范围：42-87 岁）接受了 CBCT 下结合粒子和弹簧圈治疗慢性硬膜下血肿的 17 次 MMAE包括 2022 年至 2023 年的 (SDH) (n=6)、术后 SDH (n=3) 或术前脑膜肿瘤栓塞 (n=2)。分析了技术成功、透视时间 (FT)、参考剂量 (RD)、比释动面积积 (KAP)。记录不良事件和结果。结果技术成功率为100%（17/17）。 MMAE 手术持续时间中位数为 82 分钟（四分位数间距 [IQR]：70、95；范围：63–108 分钟）。中位 FT 为 24 分钟（IQR：15、48；范围：21.5–37.5 分钟）；中位 RD 为 364 mGy（IQR：37, 684；范围：131.5–444.5 mGy）；中位 KAP 为 46.4 Gy.cm2（9.6、104.5；范围：30.2–56.6 Gy.cm2）。不需要进一步干预。不良事件发生率为9%（1/11），一名血小板减少症患者穿刺部位出现一处假性动脉瘤，采用支架置入术治疗。中位随访时间为 48 天（IQR；14, 251；范围：18.5–91 天]。随访影像学证明，15 个 SDH 中有 11 个（73%）SDH 减小，其中 10/15 个 SDH（67%）尺寸减小超过 50%。结论 CBCT 下的 MMAE 是一种高效的治疗选择，但需要适当选择患者并仔细考虑潜在风险和风险。益处对于获得最佳患者治疗结果非常重要。
PurposeThe purpose of this study was to evaluate the safety and efficacy of middle meningeal artery embolization (MMAE) performed under cone-beam computed tomography (CBCT) augmented guidance in patients with cancer.Materials and methodsEleven patients with cancer (seven women, four men; median age, 75 years; age range: 42–87 years) who underwent 17 MMAEs under CBCT with a combination of particles and coils for chronic subdural hematoma (SDH) (n= 6), postoperative SDH (n= 3), or preoperative embolization of meningeal tumor (n= 2) from 2022 to 2023 were included. Technical success, fluoroscopy time (FT), reference dose (RD), kerma area product (KAP) were analyzed. Adverse events and outcomes were recorded.ResultsThe technical success rate was 100% (17/17). Median MMAE procedure duration was 82 min (interquartile range [IQR]: 70, 95; range: 63–108 min). The median FT was 24 min (IQR: 15, 48; range: 21.5–37.5 min); the median RD was 364 mGy (IQR: 37, 684; range: 131.5–444.5 mGy); and the median KAP was 46.4 Gy.cm2(9.6, 104.5; range: 30.2–56.6 Gy.cm2). No further interventions were needed. The adverse event rate was 9% (1/11), with one pseudoaneurysm at the puncture site in a patient with thrombocytopenia, which was treated by stenting. The median follow-up was 48 days (IQR; 14, 251; range: 18.5–91 days]. SDH reduced in 11 of 15 SDHs (73%) as evidenced by follow-up imaging, with a size reduction greater than 50% in 10/15 SDHs (67%) .ConclusionMMAE under CBCT is a highly effective treatment option, but appropriate patient selection and careful consideration of potential risks and benefits is important for optimal patient outcomes.