颅底高血运脑膜瘤外科手术前栓塞术--有效性及安全性

Preoperative embolization of basicranial meningiomas with high blood flow: discussion on its effectiveness and safety

目的回顾性分析颅底高血运脑膜瘤患者外科手术前瘤体供血动脉栓塞术,评估其有效性及安全性。方法收集2008年至2015年6月接受全脑DSA检查并证实血运丰富的73例颅底脑膜瘤患者临床资料,就外科手术前瘤体供血动脉栓塞及栓塞相关并发症,瘤体切除术中出血量、手术时间进行分析。结果外科手术前31例患者(栓塞组)中接受Glubran胶栓塞16例,聚乙烯醇(PVA)颗粒栓塞14例,Glubran胶联合PVA颗粒栓塞1例;42例患者未接受栓塞(未栓塞组)。外科手术中平均出血量在栓塞组为693 ml,未栓塞组为903 ml,差异有统计学意义(P=0.047);瘤体完全切除率在栓塞组为87.1%,未栓塞组为66.7(P=0.134)。栓塞组无栓塞相关并发症发生。结论颅底高血运脑膜瘤外科手术前栓塞可有效地降低术中出血量,是安全有效的辅助治疗方法。

Objective To retrospectively analyze the clinical results of preoperative embolization in treating basicranial meningiomas with high blood flow, and to evaluate its effectiveness and safety. Methods The clinical data of 73 patients with DSA-confirmed hypervascular basicranial meningioma, who were admitted to authors＇ hospital during the period from 2008 to June 2015 and received whole brain DSA, were collected. The preoperative embolization of tumor-feeding arteries, embolization-related complications, intraoperative blood loss and operation time were analyzed. Results Before surgery a total of 31 patients received embolization （embolization group）, among them Glubran was used in 16, PYA particles in 14 and Glubran together with polyvinyl alcohol （PVA） particles in one; no preoperative embolization was adopted in 42 patients （non-embolization group）. The average bleeding volume during surgery in the embolization group and the non-embolization group was 693 ml and 903 ml respectively, the difference between the two groups was statistically significant （P=0.047）. The total resection rate of tumor of the embolization group and the nonembolization group was 87.1% and 66.7% respectively, the difference between the two groups was not statistically significant （P=0.134）. In the embolization group no embolization-related complications occurred. Conclusion In treating hypervascular basicranial meningiomas, preoperative embolization can effectively reduce the intraoperative blood loss, therefore, it is an effective supplementary treatment method.