de Jesús Gutiérrez-Baños José, Castillo-Rangel Carlos, Ivan Rodriguez-Pereira Mauricio, Ordoñez-Granja Jaime, Ponce-Ayala Aurelio, Davila-Rodriguez Daniel Oswaldo, Tovar-Fuentes Jecsán, Sarai Tovar-Jiménez Alondra, Alberto Hernández-López Juan
Endovascular Neurosurgery, Neurosurgery and Spine Surgery Department, Hospital Regional 1ro de Octubre, ISSSTE, México City, México; Endovascular Neurosurgery, Stroke Team Mexico, Mexico City, Mexico.
Neurosurgery and Spine Surgery Department, Hospital Regional 1ro de Octubre, ISSSTE, México City, México.
World Neurosurg. 2025 Mar;195:123663. doi: 10.1016/j.wneu.2025.123663. Epub 2025 Jan 30.
Meningiomas are the most common primary central nervous system tumors, often requiring surgical resection. Presurgical embolization (PSE) is used to reduce intraoperative bleeding, although its effectiveness varies. This study evaluates the safety and efficacy of PSE using ethyl-vinyl alcohol (EVOH) in meningioma surgeries.
This study included 48 patients with intracranial meningiomas treated between January 2022 and August 2024. Patients were divided into 2 groups: Group A (n = 24) underwent surgery without PSE, while Group B (n = 24) underwent surgery with PSE using EVOH. Outcomes assessed included anesthetic and surgical times, resection bleeding, total bleeding, and transfusion requirements. Meningioma size and bleeding per cm³ were also evaluated. PSE was classified into 4 grades based on liquid embolic penetrability, and its relationship with bleeding during resection was analyzed.
PSE significantly reduced anesthetic (270 vs. 372 minutes) and surgical times (222 vs. 348 minutes). Group B exhibited less resection bleeding (450 vs. 1400 ml) and total bleeding (650 vs. 1700 ml) compared to Group A, with statistically significant differences (P < 0.01). Bleeding per cm³ was significantly lower in Group B (9.33 ml/cm³) than in Group A (31.39 ml/cm³). No complications related to PSE were observed. liquid embolic penetrability grades correlated with resection bleeding, where higher-grade embolizations led to reduced bleeding.
PSE using EVOH significantly decreases surgical bleeding and time in meningioma resections without associated complications. The proposed PSE grading system (Preoperative Embolization of Meningiomas, Mexican Classification) may enhance the predictability of intraoperative bleeding control. While we acknowledge the relatively small sample size of 48 cases, we believe this study serves as a foundation to encourage the inclusion of more patients and collaboration with additional centers, aiming to further validate and standardize the classification.
脑膜瘤是最常见的原发性中枢神经系统肿瘤，常需手术切除。术前栓塞术（PSE）用于减少术中出血，但其效果各异。本研究评估了在脑膜瘤手术中使用乙烯 - 乙烯醇（EVOH）进行PSE的安全性和有效性。
本研究纳入了2022年1月至2024年8月期间接受治疗的48例颅内脑膜瘤患者。患者分为两组：A组（n = 24）未接受PSE直接进行手术，而B组（n = 24）接受使用EVOH的PSE后再进行手术。评估的结果包括麻醉时间和手术时间、切除出血、总出血量以及输血需求。还评估了脑膜瘤大小和每立方厘米的出血量。根据液体栓塞剂的穿透性将PSE分为4级，并分析其与切除术中出血的关系。
PSE显著缩短了麻醉时间（270分钟对372分钟）和手术时间（222分钟对348分钟）。与A组相比，B组的切除出血量（450毫升对1400毫升）和总出血量（650毫升对1700毫升）更少，差异具有统计学意义（P < 0.01）。B组每立方厘米的出血量（9.33毫升/立方厘米）显著低于A组（31.39毫升/立方厘米）。未观察到与PSE相关的并发症。液体栓塞剂穿透性分级与切除出血相关，较高等级的栓塞导致出血减少。
使用EVOH的PSE显著减少了脑膜瘤切除术中的手术出血和时间，且无相关并发症。所提出的PSE分级系统（脑膜瘤术前栓塞，墨西哥分类）可能会提高术中出血控制的可预测性。虽然我们承认本研究样本量相对较小，仅48例，但我们认为这项研究为鼓励纳入更多患者并与其他中心合作奠定了基础，旨在进一步验证和规范该分类。
