蝶骨嵴及中颅窝大型脑膜瘤术前栓塞的临床应用

Clinical application of preoperative embolization to large sphenoid ridge and middle cranial fossa meningiomas

目的：探讨蝶骨嵴及中颅窝大型脑膜瘤术前栓塞的应用价值。方法：对23例患者进行术前栓塞治疗，应用明胶海绵颗粒选择性栓塞肿瘤颈外动脉供血血管，栓塞后3-5天内手术切除肿瘤。结果：根据Manelfe脑膜瘤供血方式分型：Manelfe I型7例，栓塞后肿瘤显影消失，ManelfeⅡ型11例，栓塞后肿瘤显影减少60％-90％，Manelfe Ⅲ型5例，栓塞后肿瘤显影减少30％-50％。手术过程中出血量400-1100ml左右，平均有600ml左右；手术时间在3-6小时，平均4.5小时。Simpson I级切除者9例，Simpson Ⅱ级切除者6例，SimpsonⅢ级切除者3例，SimpsonⅣ级切除者5例。结论：蝶骨嵴及中颅窝大型脑膜瘤术前栓塞治疗会明显减少术中出血，缩短手术时间，降低手术难度，提高肿瘤的全切率，减少并发症的发生。

Objective ： To explore the value of preoperative embolization to large sphenoid ridge and middle cranial fossa menin-giomas. Methods：23 cases were analyzed retrospectively, the tumor arteries of external carotid artery were selective embolized with Absorbable Gelatin Sponge, after 3 to 5 days all cases were operated. Results ： According to the typing of Manelfe. The first type had 7 cases, after embolism, the developing of tumor disappeared. The second type had 11 cases, 60% - 90% of tumor developing decreased after embolism. The third type had 5 cases, 30% - 50% of tumor developing decreased after embolism. Blood loss was from 400 to 1 100 ml during operation, the mean was 600 ml. The operative time was from 3 to 6 hours, mean 4.5 hours. 9 cases achieved the first-degree resection of Simpson, 6 cases achieved secondary resection, 3 cases achieved tertiary resection, 5 cases achieved quaternary resection. Conclusions： Preoperative embolization of large sphenoid ridge and middle cranial fossa meningiomas can decrease the intraoperative blood loss, shorten the operative time, lower the operative difficulty, increase the rate of tumor resection and reduce the complications.