Bendszus M, Rao G, Burger R, Schaller C, Scheinemann K, Warmuth-Metz M, Hofmann E, Schramm J, Roosen K, Solymosi L
Department of Neuroradiology, University of Würzburg, Germany.
Neurosurgery. 2000 Dec;47(6):1306-11; discussion 1311-2.
To evaluate the effect of preoperative embolization of meningiomas on surgery and outcomes.
In a prospective study, 60 consecutive patients with intracranial meningiomas who were treated in two neurosurgical centers were included. In Center A, embolization was performed for none of the patients (n = 30). In Center B, 30 consecutive patients with embolized meningiomas were treated. Preoperatively, tumor size and location, neurological status, and Barthel scale score were recorded. In Center B, the extent of tumor devascularization was evaluated using angiography and postembolization magnetic resonance imaging. Intraoperatively, blood loss, the numbers of blood units transfused, and the observations of the neurosurgeon concerning hemostasis, tumor consistency, and intratumoral necrosis were recorded. Postoperatively, the neurological status and duration of hospitalization were recorded. Six months after surgery, the outcomes were assessed using the Barthel scale and neurological examinations.
The mean tumor sizes were 22.9 cc in Center A and 29.6 cc in Center B (P > 0.1). The mean blood losses did not differ significantly (646 ml in Center A versus 636 ml in Center B; P > 0.5). However, for a subgroup of patients with subtotal devascularization (>90% of the tumor) on postembolization magnetic resonance imaging scans in Center B, blood loss was less, compared with the entire group in Center A (P < 0.05). The observations of the neurosurgeon regarding hemostasis, tumor consistency, and intratumoral necrosis did not differ significantly. There were no surgery-related deaths in either center. The rates of surgical morbidity, with permanent neurological worsening, were 20% (n = 6) in Center A and 16% (n = 5) in Center B. There was one permanent neurological deficit (3%) caused by embolization.
In this preliminary study, only complete embolization had an effect on blood loss. The value of preoperative embolization for all meningiomas must be reconsidered, especially in view of the high costs and risks of embolization.
评估脑膜瘤术前栓塞对手术及预后的影响。
在一项前瞻性研究中，纳入了在两个神经外科中心接受治疗的60例连续性颅内脑膜瘤患者。在A中心，未对任何患者进行栓塞（n = 30）。在B中心，对30例连续性脑膜瘤栓塞患者进行了治疗。术前记录肿瘤大小和位置、神经状态及巴氏量表评分。在B中心，使用血管造影和栓塞后磁共振成像评估肿瘤去血管化程度。术中记录失血量、输血单位数量以及神经外科医生对止血、肿瘤质地和瘤内坏死的观察情况。术后记录神经状态和住院时间。术后6个月，使用巴氏量表和神经检查评估预后。
A中心肿瘤平均大小为22.9立方厘米，B中心为29.6立方厘米（P > 0.1）。平均失血量无显著差异（A中心为646毫升，B中心为636毫升；P > 0.5）。然而，在B中心栓塞后磁共振成像扫描显示肿瘤大部分去血管化（>90%）的亚组患者中，失血量比A中心的整个组少（P < 0.05）。神经外科医生对止血、肿瘤质地和瘤内坏死的观察无显著差异。两个中心均无手术相关死亡。A中心永久性神经功能恶化的手术并发症发生率为20%（n = 6），B中心为16%（n = 5）。有1例永久性神经功能缺损（3%）由栓塞引起。
在这项初步研究中，只有完全栓塞对失血量有影响。必须重新考虑对所有脑膜瘤进行术前栓塞的价值，尤其是鉴于栓塞的高成本和高风险。
