Preoperative Embolization for Parasagittal and Convexity Meningiomas: Efficacy and Safety

矢狀竇側與大腦外側腦膜瘤術前栓塞：療效與安全性

吳逸民(Yi-Ming Wu) ； 黃浩輝(Ho-Fai Wong) ； 陳耀亮(Yao-Liang Chen) ； 黃敏政(Mun-Ching Wong) ； 杜振豐(Cheng-Hong Toh)

《中華放射線醫學雜誌》 34卷4期 (2009/12) Pp. 245-252

摘要

儘管臨床上常於腦膜瘤切除前進行術前栓塞，但這亦飽受爭議。僅有些許研究分析此步驟的安全性與療效，而分析出的結果也是相當不一致。本研究進行回顧性分析，比較腦膜瘤病患接受術前栓塞與未接受術前栓塞的差異性。共分析八十七名病患資料（平均腫瘤大小49.8mm，範圍20-90mm之間），其中五十五名接受術前栓塞，另外三十二名病患則否。術前栓塞與未接受術前栓塞兩組之平均失血量（中位數）各別為650ml與700ml(p=0.595)，兩組之平均手術時間各別為382 min與432 min(p=0.125)。我們發現腫瘤大小與栓塞之間具有相關性，較大的腫瘤進行栓塞可有較好的效益，而較小的腫瘤則否。此相關性結果表示當腫瘤較小時，栓塞與失血量以及手術時間的減少的相關性較低。此相關性不因不同腫瘤位置而有統計學上有意義之差異。本研究僅記錄到一件副作用（半身不遂），不足以提供足夠的數據對於安全性下結論。小結以上，術前栓塞對於較大的腦膜瘤有較高的臨床效益。此研究的臨床重要性在於本實驗結果指出當腦膜瘤的大小小於一定程度時，栓塞對於降低失血量及手術時間是沒有顯著效益的。需要進一步的研究準確定義腫瘤大小的截止值與栓塞效益之間的關係。

並列摘要

The use of preoperative embolization before resection of meningiomas is widely practiced, but is also widely debated. Only a few controlled studies have be en conducted to investigate the safety and efficacy of this procedure, and they have produced contradictory results. We performed a retrospective study comparing patients with and without preoperative embolization for intracranial meningiomas. We reviewed the records of 87 patients, 55 who received preoperative embolization and 32 who did not. The mean tumor size was 49.8mm, range between 20-90mm. In the embolization and non-embolization groups median blood loss was 650 ml and 700 ml, respectively (P=0.595) and mean surgical time was 382.5 min and 432 min, respectively (P=0.125) We found correlations between tumor size and embolization suggesting that larger tumors benefit from embolization whereas smaller tumors do not. The direction of correlation suggested that embolization was less correlated with reduction of blood loss and reduction of surgical time as tumor size decreased. There was no significant difference of the correlation based on the tumor location (convexity vs parasagittal). Only one adverse event (hemiplegia) was recorded; this did not provide enough data to draw conclusions about safety. We concluded that preoperative embolization is not efficacious for small meningiomas. This study is clinically relevant because it shows that there is a size of meningioma below which embolization is not efficacious for reducing blood loss and surgical time. Future studies should be carried out to more accurately define the cut-off value for tumor size to obtain the benefits of embolization.