Abstract: Objective To evaluate the safety and effectiveness of combined middle meningeal artery （MMA）embolization and external drainage in the treatment of chronic subdural hematoma （cSDH） under hybrid operating room. Methods Eighty patients with cSDH who received surgical intervention from September 2021 to October 2023 in our hospital, were included in the study. Among them, 41 cases received external drainage, 39 patients received MMA embolization combined with external drainage. One patient had a collateral anastomosis between the middle meningeal artery and the ophthalmic artery branch and did not receive embolization. In another case, the embolization was terminated due to severe arteriosclerosis and tortuousness which led to microcatheter being unable to bein place. The clinical symptoms, hematoma absorption, recurrence and related complications were observed within 3 months after operation. Results The successful rate of operation was 100% in all 80 cSDH patients. The hematoma was cleared well in all patients, and there were no surgical related complications. Fourty-ome patients were treated with external drainage. Only 7 patients （8.7%） recrudesced, and 37 patients received middle meningeal artery embolization combined with external drainage for 30 patients with primary cSDH and 7 patient with recurrence. No recurrence was found during the follow-up period and the mRS score was≤2.There were statistically significant differences in the thickness of cSDH and the first and last follow-up results of mRS （P<0.01）. Conclusion Middle meningeal artery embolization combined with external drainage is safe, effective and economical for the treatment of chronic subdural hematoma in hybrid operating room, especially for the treatment of refractory chronic subdural hematoma.

Key words: hybrid operating room, chronic subdural hematoma, embolization, middle meningeal artery, external drainage

摘要： 目的 本研究旨在分析复合手术下脑膜中动脉栓塞（EMMA）联合钻孔引流治疗慢性硬膜下血肿（cSDH）的安全性及有效性。方法 收集2021年9月至2023年10月于德阳市人民医院手术干预的80例 cSDH 患者。其中41例接受单纯颅骨钻孔引流治疗;39例接受MMA栓塞联合钻孔引流治疗,其中1例脑膜中动脉与眼动脉分支存在侧支危险吻合未进行栓塞治疗;另有1例由于动脉硬化严重且走形迂曲微导管无法到位,终止栓塞。随访观察术后3个月内患者的临床症状有无改善、血肿吸收情况、复发以及相关并发症。结果 全部80例cSDH患者手术成功率100%,所有患者血肿清除良好,无手术相关并发症。41例接受单纯颅骨钻孔引流治疗,仅7例（8.7%）复发。37例接受脑膜中动脉栓塞联合钻孔引流治疗中原发患者30例,复发患者7例,随访期间均未发现复发,改良Rankin评分均≤2;第一次和最后一次的cSDH厚度、mRS评分随访值具有统计学差异（P<0.01）。结论 复合手术下行脑膜中动脉栓塞联合钻孔引流治疗慢性硬膜下血肿安全、有效、经济,尤其对于难治性慢性硬膜下血肿的治疗。

关键词: 复合手术室, 慢性硬膜下血肿, 脑膜中动脉栓塞, 钻孔引流