Suzuki Ryosuke, Akimoto Taisuke, Miyake Shigeta, Iida Yu, Shimohigoshi Wataru, Nakai Yasunobu, Shimizu Nobuyuki, Sakata Katsumi, Yamamoto Tetsuya
Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, JPN.
Department of Neurosurgery, Yokohama Brain and Spine Center, Yokohama, JPN.
Cureus. 2024 Mar 31;16(3):e57315. doi: 10.7759/cureus.57315. eCollection 2024 Mar.
Introduction Preoperative embolization can potentially facilitate surgical resection of challenging tumors in the intracranial and facial regions; however, its clinical efficacy remains controversial, mainly due to potential morbidity risks. We explored negative factors of the combined treatment of preoperative embolization and tumor resection that affect neurological prognosis. Method This retrospective study used clinical data from 132 consecutive tumors that underwent combined treatment at multiple facilities between January 2016 and May 2021. Basic patient information, tumor characteristics, and treatment details were assessed to identify predictors of deterioration as measured using the modified Rankin scale (mRS) score at three months post-treatment. Results Among the 126 eligible combined treatments, a deterioration in the postoperative mRS score was observed in 19/126 (15.1%). Complications related to embolization and tumor resection occurred in 8/126 (6.3%) and 19/125 (15.2%) of procedures, respectively. Multivariate analyses indicated significant associations between migration of embolic material (adjusted odds ratio 13.80; 95% confidence interval 1.25-152.52; p=0.03), elevated intraoperative blood loss (p=0.04), and deterioration of postoperative mRS score. Embolic material migration was identified as the primary prognostic factor for the deterioration of score. An analysis of 192 procedures, excluding those that exclusively used coils, identified embolization targeting the accessory meningeal artery (p=0.046) and the third segment of the internal maxillary artery (p=0.03) as a risk factor for embolic material migration. Conclusions Embolic material migration is the predominant factor associated with declining neurological outcome that persists into the chronic phase after combined treatment. Given that preoperative embolization is a supplementary treatment option, a thorough understanding of vascular anatomy and striving safe procedure are critical.
引言 术前栓塞术有可能促进颅内和面部区域具有挑战性的肿瘤的手术切除；然而，其临床疗效仍存在争议，主要是由于潜在的发病风险。我们探讨了术前栓塞术与肿瘤切除术联合治疗中影响神经功能预后的负面因素。方法 这项回顾性研究使用了2016年1月至2021年5月期间在多个机构接受联合治疗的132例连续肿瘤的临床数据。评估患者的基本信息、肿瘤特征和治疗细节，以确定治疗后三个月使用改良Rankin量表（mRS）评分衡量的病情恶化预测因素。结果 在126例符合条件的联合治疗中，19/126（15.1%）观察到术后mRS评分恶化。与栓塞术和肿瘤切除术相关的并发症分别发生在8/126（6.3%）和19/125（15.2%）的手术中。多因素分析表明，栓塞材料移位（调整比值比13.80；95%置信区间1.25-152.52；p=0.03）、术中失血增加（p=0.04）与术后mRS评分恶化之间存在显著关联。栓塞材料移位被确定为评分恶化的主要预后因素。对192例手术（不包括仅使用弹簧圈的手术）的分析表明，栓塞脑膜副动脉（p=0.046）和上颌内动脉第三段（p=0.03）是栓塞材料移位的危险因素。结论 栓塞材料移位是联合治疗后持续至慢性期的神经功能预后下降的主要相关因素。鉴于术前栓塞术是一种辅助治疗选择，全面了解血管解剖结构并力求手术安全至关重要。
