Chun Jay Y, McDermott Michael W, Lamborn Kathleen R, Wilson Charles B, Higashida Randall, Berger Mitchel S
Department of Neurological Surgery, Brain Tumor Research Center, University of California, San Francisco, San Francisco, California 94143-0112, USA.
Neurosurgery. 2002 Jun;50(6):1231-5; discussion 1235-7. doi: 10.1097/00006123-200206000-00010.
Embolization before surgical resection of tumors has been demonstrated to reduce intraoperative blood loss, but the optimal time that should elapse between embolization and tumor resection has not been established. We evaluated whether immediate surgical resection (< or =24 h) after embolization or delayed surgical resection (>24 h) was more effective in minimizing intraoperative blood loss.
We retrospectively analyzed the records for 50 patients with meningiomas who underwent preoperative embolization between 1993 and 1999. We divided the patients into two groups, i.e., those who underwent surgical resection of their meningiomas < or =24 hours after embolization and those who underwent surgery more than 24 hours after embolization. The extent of embolization, intraoperative blood loss, duration of surgery, and length of the hospital stay were compared for the two groups. Postoperative pathological specimens were examined for assessment of the extent of vascularity and necrosis caused by embolization.
Intraoperative blood loss was greater for the immediate group than for the delayed group (29% with blood loss of >1000 ml [median, 475 ml] versus 0% with blood loss of >700 ml [median, 337.5 ml]; P = 0.01). There were no statistically significant differences between the groups with respect to tumor volume, extent of embolization, degree of devascularization, necrosis, duration of surgery, or length of the hospital stay.
Contrary to previous studies that emphasized a need for tumor removal immediately after embolization, to prevent revascularization, surgical resection of meningiomas should be delayed more than 24 hours after embolization, because there is less intraoperative blood loss.
肿瘤手术切除前进行栓塞已被证明可减少术中失血，但栓塞与肿瘤切除之间的最佳间隔时间尚未确定。我们评估了栓塞后立即手术切除（≤24小时）或延迟手术切除（>24小时）在减少术中失血方面是否更有效。
我们回顾性分析了1993年至1999年间50例接受术前栓塞的脑膜瘤患者的记录。我们将患者分为两组，即栓塞后≤24小时接受脑膜瘤手术切除的患者和栓塞后超过24小时接受手术的患者。比较两组的栓塞程度、术中失血量、手术持续时间和住院时间。对术后病理标本进行检查，以评估栓塞引起的血管化和坏死程度。
立即手术组的术中失血量大于延迟手术组（失血>1000 ml的占29%[中位数，475 ml]，而失血>700 ml的占0%[中位数，337.5 ml]；P = 0.01）。两组在肿瘤体积、栓塞程度、去血管化程度、坏死、手术持续时间或住院时间方面无统计学显著差异。
与以往强调栓塞后需立即切除肿瘤以防止再血管化的研究相反，脑膜瘤的手术切除应在栓塞后延迟超过24小时，因为术中失血较少。
