Aihara Masanori, Naito Isao, Shimizu Tatsuya, Fujimaki Hiroya, Asakura Ken, Miyamoto Naoko, Yoshimoto Yuhei
Department of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan,
Neuroradiology. 2015 Jul;57(7):713-9. doi: 10.1007/s00234-015-1521-9. Epub 2015 Apr 7.
Preoperative embolization for intracranial meningioma has been controversial for several decades. This study retrospectively reviewed our experience using n-butyl cyanoacrylate (n-BCA) to identify the factors for effective devascularization and procedure-related complications.
Fifty-seven patients who underwent preoperative embolization with n-BCA were analyzed to collect the following data: age, sex, tumor size, location, pathology, and presence or absence of pial arterial supply. The predictive factors for total devascularization and complications were examined using univariate and multivariate analyses.
Injected n-BCA penetrated into the tumor vessels in 51 cases (89%) but resulted in feeder occlusion in 6 (11%). Angiographic total devascularization was achieved in 29 cases (51%) and partial devascularization in 28 (49%). Small size, superficial location, and absence of pial supply were independent factors for total devascularization. No major complication was encountered, but asymptomatic or transient adverse events occurred in nine patients and were significantly associated with elderly patients and large tumors.
Preoperative embolization for intracranial meningiomas using n-BCA can attain effective devascularization without major complications. The effect of preoperative embolization on surgical resection or patient outcome is still unknown.
几十年来，颅内脑膜瘤的术前栓塞一直存在争议。本研究回顾性分析了我们使用正丁基氰基丙烯酸酯（n-BCA）的经验，以确定有效去血管化的因素及与手术相关的并发症。
分析57例行n-BCA术前栓塞的患者，收集以下数据：年龄、性别、肿瘤大小、位置、病理以及软脑膜动脉供血情况。采用单因素和多因素分析来研究完全去血管化和并发症的预测因素。
51例（89%）注射的n-BCA渗入肿瘤血管，但6例（11%）导致供血动脉闭塞。血管造影显示29例（51%）实现了完全去血管化，28例（49%）实现了部分去血管化。肿瘤体积小、位置表浅以及无软脑膜供血是完全去血管化的独立因素。未出现重大并发症，但9例患者出现无症状或短暂性不良事件，且这些事件与老年患者和大肿瘤显著相关。
使用n-BCA对颅内脑膜瘤进行术前栓塞可实现有效的去血管化，且无重大并发症。术前栓塞对手术切除或患者预后的影响仍不清楚。
