Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Neurosurgery, Changhai Hospital, Naval Medical University, Shanghai, China.
Department of Neurosurgery, Changhai Hospital, Naval Medical University, Shanghai, China.
World Neurosurg. 2024 Jul;187:e722-e730. doi: 10.1016/j.wneu.2024.04.157. Epub 2024 Apr 29.
To quantitatively investigate the longitudinal computed tomography perfusion (CTP) imaging in meningiomas preoperatively embolized using microcatheters.
This retrospective monocentric study included 27 patients with symptomatic supratentorial meningiomas. Quantitative computed tomography perfusion (CTP) images before and postembolization were evaluated and correlated with angiographic, immunohistochemical, and clinical data.
The mean age of the patients was 45 ± 18 years, with a female-to-male ratio of 1.45:1. After embolization, both the embolized (Eb) and unembolized (UEb) regions showed hypoperfusion. A steady state was achieved on days 4-6 postembolization, during which differences in regional cerebral blood volume (rCBV) (Eb 0.5 ± 0.3 ml/100 mg, UEb 3.3 ± 1.4 ml/100 mg; P < 0.05), and mean transit time (MTT) (Eb 3.5 ± 1.8 s, UEb 3.1 ± 0.4 s) were observed. The cerebral blood flow (rCBF) and time to the peak (TTP) exhibited opposite patterns between Eb and UEb. A steady state was reached in rCBF (Eb 1.7 ± 1.2 ml/100 g/min, UEb 30 ± 5.4 ml/100 g/min; P < 0.01), and TTP (Eb 5 ± 4.8 s, UEb 1.8 ± 1.5 s; P < 0.01) within 4 to 6 days. Estimated blood loss (EBL) showed significant association with the surgical time interval among the 3 groups (P < 0.05). Tissue necrosis predominated over 7 days postembolization, indicating a correlation with the devascularization process. The overall incidence of postembolized headache, seizures, extremity weakness/paralysis, and postoperational headache was 11.1%, 7.4%, 3.7%; and 7.4%, respectively. All symptoms resolved by the last follow-up (3 months).
Preoperative embolization of meningiomas using N-butyl cyanoacrylate effectively induced significant and sustained tissue transformation and decreased estimated blood loss (EBL) over 7 days. Hemodynamic fluctuations tended to stabilize within 4 to 6 days.
定量研究使用微导管对脑膜瘤进行术前栓塞后的 CT 灌注（CTP）成像。
这是一项回顾性单中心研究，纳入了 27 例有症状的幕上脑膜瘤患者。评估了栓塞前后的定量 CT 灌注（CTP）图像，并与血管造影、免疫组织化学和临床数据相关联。
患者的平均年龄为 45±18 岁，男女比例为 1.45:1。栓塞后，栓塞区（Eb）和未栓塞区（UEb）均显示低灌注。栓塞后 4-6 天达到稳定状态，在此期间，区域脑血容量（rCBV）（Eb 0.5±0.3ml/100mg，UEb 3.3±1.4ml/100mg；P<0.05）和平均通过时间（MTT）（Eb 3.5±1.8s，UEb 3.1±0.4s）存在差异。Eb 和 UEb 的脑血流量（rCBF）和达峰时间（TTP）呈现相反的模式。rCBF（Eb 1.7±1.2ml/100g/min，UEb 30±5.4ml/100g/min；P<0.01）和 TTP（Eb 5±4.8s，UEb 1.8±1.5s；P<0.01）在 4-6 天内达到稳定状态。估计失血量（EBL）与 3 组之间的手术时间间隔有显著相关性（P<0.05）。栓塞后 7 天内，组织坏死占主导地位，表明与去血管化过程相关。栓塞后头痛、癫痫发作、肢体无力/瘫痪和术后头痛的总发生率分别为 11.1%、7.4%、3.7%和 7.4%。所有症状在最后一次随访（3 个月）时均已缓解。
使用 N-丁基氰基丙烯酸酯对脑膜瘤进行术前栓塞可有效诱导显著和持续的组织转化，并在 7 天内减少估计失血量（EBL）。血流动力学波动在 4-6 天内趋于稳定。
