Department of Neurosurgery, Kyoto University Graduate School of Medicine, ShogoinKawahara-cho, Sakyo-ku, 606-8507, Kyoto, Japan.
Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan.
BMC Neurol. 2021 Mar 12;21(1):113. doi: 10.1186/s12883-021-02129-4.
Removal of large hypervascular tumors in the lateral ventricle still poses a surgical challenge. These tumors are usually fed from choroidal arteries, and vascular control is typically performed late during the removal. We aimed to evaluate the clinical efficacy of our strategy for persistent preoperative obliteration of feeders from the choroidal arteries to manage large hypervascular tumors in the lateral ventricle.
We retrospectively analyzed six patients with hypervascular tumors in the lateral ventricle. We first attempted to obstruct feeders using endovascular treatment, and, if unavailable, performed initial microsurgical occlusion through the temporal horn for the staged tumor removal.
In all patients, feeder obliteration was successfully performed; the anterior choroidal arteries were occluded by the endovascular treatment and microsurgical occlusion in one and five patients, respectively, while the lateral posterior choroidal arteries were occluded via endovascular treatment in four patients. No patients had permanent symptoms due to feeder obliteration, and tumor devascularization was achieved at the mean rate of 69.9%. During the tumor removal, the mean blood loss volume was 253 ml. No postoperative hemorrhage had occurred, and all patients scored ≤ 2 on the modified Rankin Scale at six months post-removal.
Although further studies are warranted, persistent feeder obliteration of choroidal arteries could be an effective treatment strategy against large hypervascular tumors in the lateral ventricle.
侧脑室内大型富血管肿瘤的切除仍然是一项具有挑战性的手术。这些肿瘤通常由脉络膜动脉供血，血管控制通常在切除过程的后期进行。我们旨在评估我们持续术前闭塞脉络膜动脉供血支以处理侧脑室内大型富血管肿瘤的策略的临床疗效。
我们回顾性分析了 6 例侧脑室内富血管肿瘤患者。我们首先尝试通过血管内治疗来闭塞供血支，如果不可行，则通过颞角进行初始显微手术闭塞，以分期切除肿瘤。
在所有患者中，均成功地进行了供血支闭塞；在前脉络膜动脉闭塞中，有 1 例患者通过血管内治疗，5 例患者通过显微手术闭塞；而在 4 例患者中，通过血管内治疗闭塞了外侧后脉络膜动脉。没有患者因供血支闭塞而出现永久性症状，肿瘤的血供阻断率平均为 69.9%。在肿瘤切除过程中，平均失血量为 253ml。没有发生术后出血，所有患者在术后 6 个月时改良 Rankin 量表评分均≤2。
尽管还需要进一步的研究，但持续闭塞脉络膜动脉的供血支可能是治疗侧脑室内大型富血管肿瘤的有效策略。
