Kato Amami, Fujimoto Yasunori, Taniguchi Masaaki, Hashimoto Naoya, Hirayama Azuma, Kinoshita Manabu, Baba Takahito, Maruno Motohiko, Yoshimine Toshiki
Department of Neurosurgery, Osaka University Medical School, Suita, Japan.
J Neurosurg. 2004 Nov;101(5):779-86. doi: 10.3171/jns.2004.101.5.0779.
Controlling hemorrhage is crucial in the safe and efficient removal of large meningiomas. Intravascular embolization is not always a satisfactory means of accomplishing this goal because of the procedure's hemostatic effect and risk of complications. The authors in this study used a volumetric thermal ablation technique incorporating radiofrequency energy, image guidance, and local temperature control to devascularize tumor tissue.
Five patients with large meningiomas were treated. The target and orientation of the radiofrequency thermal ablation (RFTA) were simulated preoperatively to maximize devascularization of the lesion without thermal injury to adjacent critical structures. Image fusion, three-dimensional reconstruction, and image-guided methods provided for optimized trajectories and targets for insertion of the RFTA needle. During ablation, local temperatures of the tissue being cauterized were monitored continuously to limit the ablated lesion to within the target volume. The effects of devascularization and the softening of the tumor parenchyma facilitated lesion removal. The intracranial ablated meningioma changed into necrotic tissue and shrank within a few months. Histopathological examination of the ablated lesion revealed sharply demarcated coagulation necrosis.
Volumetric thermal devascularization can be applied safely in the treatment of large meningiomas to facilitate surgical manipulation of the lesion as well as to reduce its size palliatively. The procedure's usefulness should be studied further in a larger number of cases with different tumor characteristics.
在安全、有效地切除大型脑膜瘤过程中，控制出血至关重要。血管内栓塞术并不总是实现这一目标的理想方法，因为该手术存在止血效果及并发症风险。本研究的作者采用了一种结合射频能量、图像引导和局部温度控制的容积性热消融技术，使肿瘤组织血管化。
对5例大型脑膜瘤患者进行了治疗。术前对射频热消融（RFTA）的靶点和方向进行了模拟，以在不热损伤相邻关键结构的情况下最大限度地使病变血管化。图像融合、三维重建和图像引导方法为RFTA针的插入提供了优化的轨迹和靶点。在消融过程中，持续监测被烧灼组织的局部温度，以将消融病变限制在目标体积内。血管化和肿瘤实质软化的效果有助于病变切除。颅内消融的脑膜瘤在几个月内变成坏死组织并缩小。对消融病变的组织病理学检查显示有界限分明的凝固性坏死。
容积性热血管化可安全应用于大型脑膜瘤的治疗，以利于病变的手术操作并减轻其大小。该手术的有效性应在更多具有不同肿瘤特征的病例中进一步研究。
