巨大凸面脑膜瘤术前栓塞疗效分析  

Preoperative embolization of giant convex meningioma

作　　者：凌海平 那世杰[1] 刘涛[1] 庄宗 张玉华 杭春华 张庆荣 Ling Haiping;Na Shijie;Liu Tao;Zhuang Zong;Zhang Yuhua;Hang Chunhua;Zhang Qingrong(Department of Neurosurgery,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院神经外科,南京210008

出　　处：《中华脑科疾病与康复杂志（电子版）》2021年第4期209-214,共6页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

摘　　要：目的分析利用术前栓塞硬脑膜供血动脉辅助显微外科手术治疗凸面脑膜瘤患者的临床特点及其临床疗效。方法回顾性分析南京大学医学院附属鼓楼医院神经外科自2020年6月至11月收治的6例术前栓塞的凸面脑膜瘤患者的临床资料,包括肿瘤的大小、供血动脉来源、栓塞动脉、栓塞程度、切除术中预估出血量以及出院时改良Rankin量表(mRs)评分,同时收集同时期内未行术前栓塞的直径超过5 cm的凸面脑膜瘤患者的相关资料作为对照组,对比分析2组患者的术中预估出血量以及mRs评分。结果本组患者均有多支血管参与供血,均行脑膜中动脉栓塞,均为大部分栓塞,其中1例患者同时行颞浅动脉远端栓塞。栓塞术后,1例患者肿瘤周围水肿加重,1例患者出现癫痫发作及肢体肌力下降,切除术后肌力恢复,均无出血及梗死症状。术前栓塞组及非栓塞组患者肿瘤大小分别为61.0(51.0,76.0)、53.5(51.0,59.8)mm,术前栓塞组和非栓塞组的预估出血量分别为900.0(375.0,1425.0)、1000.0(675.0,1225.0)mL,2组比较差异均无统计学意义(P>0.05)。2组患者出院时均无新增神经功能障碍。结论手术切除体积较大的凸面富血供脑膜瘤是一种存在一定风险的治疗方式,术前栓塞肿瘤脑膜供血动脉可能是控制出血的有效方式,但目前仍缺乏较好的评价指标。Objective To explore the clinical effect and analyze the clinical characteristics of patients who has convex meningioma and used preoperative embolization of dural artery to assist the treatment.Methods The clinical data of 6 patients with convex meningiomas treated by preoperative embolization artery embolization,admitted to Neurosurgery Department of Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from June to November 2020,were analyzed retrospectively,including feeding artery,embolic artery,degree of embolization,estimated blood loss during resection and modified Rankin scale(mRs)at discharge.The relevant data of patients with convex meningiomas with a diameter of more than 5 cm without preoperative embolization during the same period were collected as the control group.The intraoperative estimated bleeding volume and mRs score of the two groups were compared and analyzed.Results In this group,multiple blood vessels participated in the blood supply.All patients underwent middle meningeal artery embolization and were treated with partial embolism,1 patient underwent simultaneous embolization of superficial temporal artery at the same time.After embolization,the peritumoral edema was aggravated in 1 patient,epilepsy and decreased limb muscle strength in 1 patient,and muscle strength recovered after resection.There were no bleeding and infarction after embolization.The tumor size of preoperative embolization group and non embolization group were 61.0(51.0,76.0)mm and 53.5(51.0,59.8)mm respectively,the estimated blood loss of preoperative embolization group and non embolization group were 900.0(375.0,1425.0)mL and 1000.0(675.0,1225.0)mL respectively.There was no significant difference in tumor size and estimated bleeding between the two groups(P>0.05).There was no new neurological dysfunction in both groups at discharge.Conclusion Surgical resection of large convex meningioma with rich blood supply is a high-risk treatment.Preoperative embolization of the meningeal artery

关 键 词：脑膜瘤 术前栓塞 脑膜中动脉 

分 类 号：R739.45[医药卫生—肿瘤]