Manelfe C, Lasjaunias P, Ruscalleda J
AJNR Am J Neuroradiol. 1986 Sep-Oct;7(5):963-72.
The goal of preoperative embolization of intracranial meningiomas is to facilitate their surgical removal by reducing tumor vascularity and decreasing blood loss during surgery. This study is based on personal experience with about 100 embolized meningiomas and on the experience of others. Embolization is performed during the same session as diagnostic angiography. The appropriate embolic materials (absorbable or nonabsorbable) are chosen according to the location of the tumor, the size of the feeding arteries, the blood flow, and the presence of any potentially dangerous vessels (dangerous anastomoses between external carotid artery and internal carotid or vertebral arteries, arteries supplying the cranial nerves). Preoperative embolization appeared to be very useful in large tumors with pure or predominant external carotid artery supply (convexity meningiomas), in skull-base meningiomas, and in middle fossa and paracavernous meningiomas. It was also useful in falx and parasagittal meningiomas receiving blood supply from the opposite side and in posterior fossa meningiomas. CT low densities demonstrated after embolization did not always correlate with necrosis on microscopic examination, and large areas of infarction could be found despite normal CT. Embolic material was found on pathologic examination in 10%-30% of cases; fresh or recent ischemic and/or hemorrhagic necrosis consistent with technically successful embolization was demonstrated in 40%-60% of cases. With careful technique complications are rare.
颅内脑膜瘤术前栓塞的目的是通过减少肿瘤血管供应和术中失血，便于手术切除。本研究基于本人对约100例栓塞脑膜瘤的经验以及他人的经验。栓塞与诊断性血管造影在同一阶段进行。根据肿瘤位置、供血动脉大小、血流情况以及是否存在任何潜在危险血管（颈外动脉与颈内动脉或椎动脉之间的危险吻合支、供应颅神经的动脉）选择合适的栓塞材料（可吸收或不可吸收）。术前栓塞在单纯或主要由颈外动脉供血的大型肿瘤（凸面脑膜瘤）、颅底脑膜瘤、中颅窝和海绵旁脑膜瘤中似乎非常有用。在接受对侧供血的镰旁和矢状旁脑膜瘤以及后颅窝脑膜瘤中也很有用。栓塞后CT低密度表现并不总是与显微镜检查下的坏死相关，尽管CT正常，但仍可发现大面积梗死。10%-30%的病例在病理检查中发现栓塞材料；40%-60%的病例显示与技术上成功栓塞相符的新鲜或近期缺血性和/或出血性坏死。采用谨慎的技术，并发症很少见。
