后颅窝非囊结节型血管母细胞瘤术前栓塞的效果分析

Clinical effect of preoperative embolization of non-capsular nodular hemangioblastoma in the posterior fossa

目的探讨后颅窝非囊结节型血管母细胞瘤(HB)术前栓塞的安全性和有效性。方法回顾性分析新疆医科大学第一附属医院神经外科中心肿瘤病区自2014年1月至2018年6月收治的12例后颅窝非囊结节型HB患者的临床资料,患者均行术前栓塞,栓塞后行显微神经外科手术切除肿瘤,观察栓塞后及术后并发症发生情况并采用KPS评分评价治疗效果。结果后颅窝非囊结节型HB多支血管共同参与供血,本组患者完全栓塞5例,大部分栓塞5例,部分栓塞2例。栓塞后显微神经外科手术全切11例,肿瘤次全切1例。平均手术时间5.3 h,术中出血200～1500 mL,平均出血680 mL。1例患者术后后组颅神经麻痹,发生吸入性肺炎;1例出现颅内感染。术后KPS评分均≥90分,可进行正常活动。结论术前栓塞是后颅窝非囊结节型HB安全有效的辅助治疗方法,可有效减少术中出血,缩短手术时间,减少手术并发症,提高患者术后生活质量。

Objective To investigate the safety and efficacy of preoperative embolization for non-capsular nodular hemangioblastoma (HB) in the posterior fossa. Methods Retrospective analysis of 12 cases of posterior cranial fossa non-cystic nodular HB patients admitted to the Department of Neurosurgery, the First Affiliated Hospital of Xinjiang Medical University from January 2014 to June 2018. All patients underwent preoperative embolization and microsurgical resection after embolization. The occurrence of complications after embolization and post-operative complications were observed and the therapeutic effect was evaluated by KPS score. Results The posterior cranial fossa non-cystic nodular HB multi-vessels were involved in blood supply. The patients in this group were completely embolized in 5 cases, most of them were embolized in 5 cases, and some embolization in 2 cases. After embolization, 11 cases underwent microsurgery and 1 case underwent total tumor resection. The average operation time was 5.3 h;the intraoperative blood loss was 200-1500 mL, and the average bleeding was 680 mL. One patient had postoperative cranial nerve palsy and aspiration pneumonia;one patient developed intracranial infection. Postoperative KPS scores were ≥90 points, the patient can perform normal activities. Conclusion Preoperative embolization is a safe and effective adjuvant treatment for non-capsular nodular HB in the posterior fossa. It can effectively reduce intraoperative bleeding, shorten the operation time, reduce the complications of surgery and improve the postoperative quality of life.