Outcome analysis of preoperative embolization in cranial base surgery
Outcome analysis of preoperative embolization in cranial base surgery
复制标题
DOI：
10.1007/s00701-002-0965-y
复制
发表时间：
2002-01-01
影响因子：
2.4
通讯作者：
Bank, WO
中科院分区：
文献类型：
--
作者：
Rosen, CL;Ammerman, JM;Bank, WO
Objective.颅底肿瘤的管理需要跨学科的方法。超选择性血管造影和栓塞是颅底外科手术的重要辅助手段。虽然成功的栓塞有助于切除，但这种手术的发病率仍然不清楚。因此，我们着手确定与颅底脑膜瘤栓塞相关的发病率，从而在考虑这种辅助肿瘤切除术时做出明智的决定。回顾性分析了167例颅底脑膜瘤的栓塞治疗经验。颅底脑膜瘤是指起源于嗅沟、鞍结节、蝶骨内侧翼、岩斜区或枕骨大孔的肿瘤。栓塞供血血管280支，平均每支1.7支。在91%的栓塞患者中，实现了良好至极好的栓塞，无永久性神经系统后遗症。在20例患者中，由于存在新发神经功能缺损或缺乏适当血管进行栓塞的风险，未尝试栓塞。21例患者（12.6%）的神经系统检查出现一过性恶化或出现需要住院治疗的医学并发症。15例患者（9%）因栓塞而发生永久性神经功能缺损或医学疾病。发生严重并发症的患者中有4例患者的颅神经功能下降。颅底肿瘤的栓塞治疗是颅底病变治疗的重要组成部分。认识到这种手术的发病率将允许最适当地使用这种强大的辅助颅底手术。
Objective. Management of cranial base tumors requires an interdisciplinary approach. Supraselective angiography and embolization is an important adjunct to cranial base surgery. Though successful embolization facilitates resection, the morbidity of this procedure remains poorly defined. Therefore, we set out to define the morbidity associated with embolization of skull base meningiomas, thus allowing for informed decision making when considering this adjunct to tumor resection.Methods. A retrospective analysis was performed on our experience with embolization of 167 cranial base meningiomas. Cranial base meningiomas were defined as tumors originating from the olfactory groove, tuberculum sella, medial sphenoid wing, petro-clival region or foramen magnum.Results. 280 feeding vessels were embolized with an average of 1.7 vessels per lesion. In 91% of patients embolized, good to excellent embolization was achieved without permanent neurological sequelae. In 20 patients no embolization was attempted due to the risk of new neurologic deficits or lack of an appropriate vessel for embolization. Twenty-one patients (12.6%) had transient worsening of their neurologic exam or a medical complication requiring hospitalization. Fifteen patients (9%) experienced permanent neurologic deficits or medical morbidity as a result of embolization. Four of the patients who experienced major complications had a decline in previously compromised cranial nerve function.Conclusions. Embolization of cranial base tumors is an important part of the therapeutic armamentarium for the treatment of cranial base lesions. Recognition of the morbidity of this procedure will allow for the most appropriate use of this powerful adjunct to cranial base surgery.