Therapeutic Efficacy of Drilling Drainage Combined with Intraoperative Middle Meningeal Artery Occlusion in the Management of Chronic Subdural Hematoma: A Clinical Study
Authors: Sun Tao , Shao Dongqi , Li Jian , Xu Decai , Zhang Tao , Li Lei , Zhang Caihong , Wen Xinjie , Chen Haonan , Zhang Renhao , Jiang Zhiquan 
Published: April 2024

Abstract
BACKGROUND: The location of bone holes in the skull during surgical drainage was accurately located on the MMA, and the MMA was cut off and hematoma was removed during surgery, so that surgical drainage became a method to remove the pathogenic factors of CSDH. The aim of this study was to describe and compare the results of the new treatment with the traditional surgical drainage, and to investigate the relevance of this approach.
METHODS: From December 2021 to June 2023, 72 patients were randomly assigned to the observation group and the control group. The control group was treated with traditional surgical drainage, while the observation group was treated with DSA imaging to accurately locate the bone holes drilled in the skull on the MMA trunk before traditional surgical drainage, and the MMA trunk was cut off at the same time with surgical drainage hematoma. The recurrence rate, time of indwelling drainage tube, complications, mRS And other indicators of the two groups were compared, and the changes of cytokine components and imaging characteristics of the patients were collected and analyzed.
RESULTS: 27 patients with 29-side hematoma in the observation group and 45 patients with 48-side hematoma in the control group were included in the study. The recurrence rate was 0/29 in the observation group and 4/48 in the control group, and the recurrence rate in the observation group was lower than that in the control group (P value=.048). The mean indwelling time of the drainage tube in the observation group was 2.04±0.61 days, and that in the control group was 2.48±0.61 days. The indwelling time of the drainage tube in the observation group was shorter than that in the control group (P value=.003). There were no surgical complications in the observation group and the control group. The differences of mRS Scores before and after operation between the observation group and the control group were statistically significant (P value=.000 and =.000). The concentration level of cytokine IL6/IL8/IL10/VEGF in hematoma fluid of observation group and control group was significantly higher than that of venous blood (P value <.001). After intraoperative irrigation and drainage, the concentration level of cytokine IL6/IL8/IL10/VEGF in subdural hematoma fluid was significantly lower than that before surgery. In the observation group, the number of MMA on the hematoma side (11/29) before STA development was more than that on the non-hematoma side (1/25), and the difference was statistically significant (P value=.003).
CONCLUSION: The accurate location of MMA in surgical trepanation and drainage of CSDH patients, the removal of MMA while drainage and drainage of hematoma, can reduce the recurrence rate and reduce the retention time of drainage tube, significantly improve the postoperative mRS Score, no increase in surgical complications.