Is there a benefit of preoperative meningioma embolization?

被引:119
作者
Bendszus, M
Rao, G
Burger, R
Schaller, C
Scheinemann, K
Warmuth-Metz, M
Hofmann, E
Schramm, J
Roosen, K
Solymosi, L
机构
[1] Univ Wurzburg, Dept Neuroradiol, D-97080 Wurzburg, Germany
[2] Univ Wurzburg, Dept Neurosurg, D-97080 Wurzburg, Germany
[3] Univ Bonn, Dept Neurosurg, D-5300 Bonn, Germany
关键词
embolization; meningioma surgery;
D O I
10.1097/00006123-200012000-00008
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE: To evaluate the effect of preoperative embolization of meningiomas on surgery and outcomes. METHODS: In a prospective study, 60 consecutive patients with intracranial meningiomas who were treated in two neurosurgical centers were included. In Center A, embolization was performed for none of the patients (n = 30). In Center B, 30 consecutive patients with embolized meningiomas were treated. Preoperatively, tumor size and location, neurological status, and Barthel scale score were recorded. In Center B, the extent of tumor devascularization was evaluated using angiography and postembolization magnetic resonance imaging. Intraoperatively, blood loss, the numbers of blood units transfused, and the observations of the neurosurgeon concerning hempstasis, tumor consistency, and intratumoral necrosis were recorded. Postoperatively, the neurological status and duration of hospitalization were recorded. Six months after surgery, the outcomes were assessed using the Barthel scale and neurological examinations. RESULTS: The mean tumor sizes were 22.9 cc in Center A and 29.6 cc in Center B (P > 0.1). The mean blood losses did not differ significantly (646 mi in Center A versus 636 mi in Center B; P > 0.5). However, for a subgroup of patients with subtotal devascularization (>90% of the tumor) on postembolization magnetic resonance imaging scans in Center B, blood loss was less, compared with the entire group in Center A (P < 0.05). The observations of the neurosurgeon regarding hemostasis, tumor consistency, and intratumoral necrosis did not differ significantly. There were no surgery-related deaths in either center. The rates of surgical morbidity, with permanent neurological worsening, were 20% (n = 6) in Center A and 16% (n = 5) in Center B. There was one permanent neurological deficit (3%) caused by embolization. CONCLUSION: In this preliminary study, only complete embolization had an effect on blood loss. The value of preoperative embolization for all meningiomas must be reconsidered, especially in view of the high costs and risks of embolization.
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页码:1306 / 1311
页数:6
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