富血供巨大脑膜瘤全脑血管造影及术前栓塞疗效观察

Application of whole cerebral angiography and preoperative embolization in treating intracranial hypervascular huge meningiomas

目的评价全脑血管造影及经动脉栓塞术对巨大富血供脑膜瘤术前栓塞的临床意义。方法2008年5月-2012年5月共治疗脑膜瘤108例，其中巨大富血供脑膜瘤28例，均经影像学及病理证实。先行全脑血管造影，包括双侧颈内、颈外及双侧椎动脉．了解脑膜瘤供血动脉情况及选择需要栓塞的颈外动脉分支。26例行术前栓塞，2例未行栓塞。所有全部或部分栓塞患者均在1～3d后行手术切除肿瘤。结果28例中，完全栓塞12例，均为颈外动脉供血；部分栓塞14例，均为颈内、外动脉或颈外与椎基底动脉参与供血；未栓塞2例．均为完全颈内动脉供血。患者均在栓塞后1～3d进行开颅手术切除肿瘤。在肿瘤完全栓塞及部分栓塞患者的切除术中，出血量明显减少，手术时间显著缩短，肿瘤易被彻底切除。未发生与栓塞操作有关的严重并发症。结论富血供巨大脑膜瘤术前全脑血管造影及栓塞能减少术中出血，降低手术难度。

Objective To evaluate the whole cerebral angiography and preoperative embolization in treating intracranial hypervascular huge meningiomas. Methods During the period from May 2008 to May 2012, a total of 108 patients with meningioma were admitted to authors＇ hospital. Of the 108 patients, 28 had hypervascular huge meningioma. The diagnosis was confirmed by angiography and pathology in all patients. Whole cerebral angiography, including bilateral internal and external carotid arteries as well as bilateral vertebral arteries, was performed in order to clarify the feeding arteries and to select the target branches of external carotid artery for embolization. Preoperative embolization was carried out in 26 cases. All patients received surgery within 1 - 3 days after the embolization. Results Of the 28 cases, complete embolization was conducted in 12 （42.9%） whose feeding arteries originated from external carotid artery, and partial embolization in 14 （50.0%） whose feeding arteries originated from both internal and external carotid artery, or from external carotid artery and vertebro-basilar artery. Embolization procedure was not employed in the remaining two cases （7.1%） whose feeding arteries originated from internal carotid artery only. In patients who had received preoperative embolization the amount of blood loss was markedly smaller than usual, and the operation time was obviously reduced. Conclusion For the treatment of intraeranial hypervascular huge meningiomas, preoperative whole cerebral angiography and embolization can significantly reduce the blood loss during the cerebral surgery.