Visualization of angiographical arteriovenous shunting in perisylvian glioblastomas
Visualization of angiographical arteriovenous shunting in perisylvian glioblastomas
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DOI：
10.1007/s00701-013-1650-z
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发表时间：
2013-04-01
影响因子：
2.4
通讯作者：
Hayashi, Y.
中科院分区：
文献类型：
--
作者：
Yoshikawa, A.;Nakada, M.;Hayashi, Y.
血管造影显示的动静脉分流是胶质母细胞瘤的主要特征之一，而动静脉分流的显示依赖于广泛分流的存在。广泛的动静脉分流与术中出血控制不良的风险有关。当有广泛的动静脉分流的肿瘤位于大脑的口才区域附近时，需要进行细致的外科手术。在这项研究中，血管造影动静脉分流的定位可视化从外科治疗的角度进行了评估，特别关注靠近运动和语言区域(优势半球)的胰周区域，以及大的动脉和静脉。所有患者均行数字减影血管造影术。根据肿瘤的部位将患者分为两组：1)乙状旁区胶质母细胞瘤(18例)和2)非乙状旁区胶质母细胞瘤(8例)。血管造影术检测动静脉分流情况。此外，两组的肿瘤内血管数量、肿瘤增殖活性(MiB-1标记指数)和术中出血量进行了评估和比较。血管造影动静脉分流在18例肾周神经胶质母细胞瘤中明确显示了13例(72%)，而在8例非肾周神经胶质母细胞瘤中只有1例(13%)(p=0.007)。两组在肿瘤内血管数、MIB-1标记指数和术中出血量方面无显著差异。然而，术中2,000毫升的大量出血发生在肾周神经胶质母细胞瘤患者中。肾周神经胶质母细胞瘤往往与广泛的动静脉分流有关，这可以通过血管造影明确显示。由于动静脉分流术存在术中出血的风险，因此应采用细致的手术方法和策略切除肾周神经胶质母细胞瘤，尤其是位于优势半球的肿瘤。
Arteriovenous shunting visualized by angiography is one of the major features of glioblastomas, and the visualization is dependent on the presence of extensive shunting. Extensive arteriovenous shunting is associated with the risk of poorly controlled intraoperative bleeding. When a tumor with extensive arteriovenous shunting is located in close proximity to the eloquent regions of the brain, a meticulous surgical procedure is necessary. In the present study, the site-oriented visualization of angiographical arteriovenous shunting was evaluated from the perspective of surgical treatment, with a particular focus on the perisylvian region that is in close proximity to motor and language regions (dominant hemisphere), as well as large arteries and veins.Twenty-six consecutive patients underwent a resection of glioblastoma between February 2007 and September 2012. All patients were presurgically examined using digital subtraction angiography. The patients were subdivided into the following two groups based on the location of the tumor: 1) perisylvian glioblastoma (18 patients) and 2) non-perisylvian glioblastoma (eight patients). Angiography to detect the arteriovenous shunting was performed. In addition, the number of intratumoral vessels, tumor proliferative activity (MIB-1 labeling index), and volume of intraoperative bleeding were evaluated and compared between the two groups.Angiographical arteriovenous shunting was definitively visualized in 13 of 18 (72 %) perisylvian glioblastomas, in contrast to only one of eight (13 %) non-perisylvian glioblastomas (p = 0.007). There were no significant differences between the two groups with respect to the number of intratumoral vessels, MIB-1 labeling index, and volume of intraoperative bleeding. However, massive intraoperative bleeding of > 2,000 mL occurred in one perisylvian glioblastoma patient.Glioblastomas in the perisylvian region tend to be associated with extensive arteriovenous shunting that can be definitively visualized by performing an angiography. Because arteriovenous shunting carries the risk of intraoperative bleeding, perisylvian glioblastomas-particularly in the dominant hemisphere-should be resected with a meticulous surgical procedure and strategy.