术前超选择性栓塞高血运脑膜瘤98例的临床意义

目的探讨术前超选择性血管内栓塞对高血运脑膜瘤的疗效和临床意义.方法在术前3～9d,对98例高血运脑膜瘤行DSA检查和微导管超选择栓塞肿瘤供血动脉,栓塞的材料包括PVA颗粒、明胶海绵和真丝线段等.栓塞后行手术切除肿瘤.结果高血运脑膜瘤主要由脑膜中动脉、咽升动脉、枕动脉、颌内动脉及副脑膜动脉供血.栓塞后,42例肿瘤染色在影像学上完全消失,56例肿瘤染色大部分或部分消失.绝大部分患者均在栓塞后的3～9d进行了开颅手术切除肿瘤.全切除肿瘤64例,术中平均出血950ml;次全切除34例,术中平均出血1 500ml.结论最佳手术时机是栓塞后7～9d.高血运脑膜瘤的术前栓塞能明显减少术中出血,提高手术安全性及全切率,是一种安全、有效的微侵袭方法.

Clinical significance of preoperative endovascular embolization in treatment of patients with vascularized meningioma

Objective To investigate the clinical efficacy and significance of preoperative superselective endovascular embolization in treatment of patients with vascularized meningioma.Methods 3 9d before operation,98 patients with vascularized meningioma underwent DSA and preoperative superselective embolization with PVA particles,gelatin sponge and silk.The surgical intervention was performed after embolization.Results The vascularized meningioma was mainly supplied by the middle meningeal artery,ascending pharyngeal artery,occipital artery,internal maxillary artery as well as submeningeal artery.After the supplying artery was embolized,tumors staining in 42 cases disappeared completely and that of 56 cases disappeared mostly or partly.Most patients were operated on 3 9d after embolization.64 tumors were removed completely,while other 34 cases were removed mostly or partly.The average volume of bleeding during the operation was 950ml in the former and 1500ml in the latter.Conclusion The best time for operation is 7 9d after embolization.Preoperative embolization of the vascularized meningioma contributes to reduce the bleeding significantly during the operation,increase the safety of the operation and improve the total removal of the tumor.It is a safe and effective microinvasive method.