Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan.
Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan.
Clin Neurol Neurosurg. 2024 Mar;238:108178. doi: 10.1016/j.clineuro.2024.108178. Epub 2024 Feb 16.
Preoperative embolization for meningiomas is controversial regarding its effectiveness in reducing intraoperative blood loss and operative time. In contrast, some reports have documented improved surgical outcomes in large meningiomas. In this study, we retrospectively compared the outcomes of craniotomy for meningiomas with/without preoperative embolization with diluted N-butyl-2-cyanoacrylate (NBCA) primarily in a single institution.
Data (World Health Organization grade, Simpson grade, maximum tumor diameter, intraoperative bleeding, operative time, history of hypertension, and time from embolization to craniotomy) of patients with initial intracranial meningiomas were compared with or without preoperative embolization from January 2015 to April 2022.
The embolization group consisted of 56 patients and the nonembolization group included 76 patients. Diluted NBCA (13% concentration for all patients) was used in 51 of 56 patients (91.1%) who underwent transarterial embolization. Permanent neurological complications occurred in 2 (3.6%) patients. Intraoperative bleeding was significantly lower in the embolization group for a maximum tumor diameter ≥40 mm (155 vs. 305 ml, respectively, p < 0.01). In the nonembolization group, for a maximum tumor diameter ≥30 mm, patients with hypertension had more intraoperative bleeding than non-hypertensive ones.
Despite its limitations, the present results showed that, under certain conditions, preoperative embolization for intracranial meningiomas caused less intraoperative bleeding. The safety of treatment was comparable with that reported in the Japan Registry of NeuroEndovascular Therapy 3 (JR-NET3) with a complication rate of 3.7% for preoperative embolization of meningiomas, despite the treatment focused on the liquid embolization material.
脑膜瘤术前栓塞在减少术中出血量和手术时间方面的效果存在争议。相比之下，一些报道记录了在大型脑膜瘤中手术结果的改善。在本研究中，我们主要在一家机构回顾性比较了有/无术前稀释 N-丁基-2-氰基丙烯酸酯 (NBCA) 栓塞的脑膜瘤开颅术的结果。
比较了 2015 年 1 月至 2022 年 4 月期间因颅内初始脑膜瘤而接受治疗的患者的术前栓塞与无术前栓塞的数据（世界卫生组织分级、辛普森分级、最大肿瘤直径、术中出血量、手术时间、高血压病史和栓塞至开颅手术的时间）。
栓塞组 56 例，非栓塞组 76 例。56 例行经动脉栓塞术的患者中，51 例（91.1%）使用稀释 NBCA（所有患者浓度为 13%）。2 例（3.6%）患者发生永久性神经并发症。对于最大肿瘤直径≥40mm 的患者，栓塞组的术中出血量明显低于非栓塞组（分别为 155ml 和 305ml，p<0.01）。在非栓塞组中，对于最大肿瘤直径≥30mm 的患者，高血压患者的术中出血量多于非高血压患者。
尽管存在局限性，但本研究结果表明，在某些情况下，颅内脑膜瘤术前栓塞可减少术中出血。治疗的安全性与日本神经血管治疗登记研究 3（JR-NET3）报告的结果相当，脑膜瘤术前栓塞的并发症率为 3.7%，尽管治疗重点是液体栓塞材料。
