抄録
Preoperative embolization has been performed between 1 and 7 days prior to surgery to reduce blood loss during surgical excision of 12 intracranial meningiomas, which possessed predominant external carotid vascularization; 5 convexity, 3 falx, 2 sphenoidal ridge and 2 parasagittal meningiomas. Cerebral catheterizations were performed through the retrograde transfemoral route. The embolization in all cases was effected with pieces of gelfoam in two different sizes, measuring 1×1×1 mm and 2×2×5 mm. The smaller pieces of gelfoam were firstly delivered through a catheter, followed by the larger ones. On computed tomography (CT) scanning after embolization, reduction of contrast enhancement was demonstrated in 9 cases, which coincided with the cases of successful occlusion of the main feeding arteries. On pathological examination of the surgical specimens, fragments of the gelfoam were demonstrated in the arterial lumen of the dura mater attached to the tumor, but no fragments were found in the fine vessels deep within the tumors. There were local or extensive hemorrhagic infarctions with an infiltration of inflammatory cells and acute ischemic necrotic lesions of the tumors with an infiltration of foamy cells. Macroscopic hemorrhage around the tumor was also found in a case. There were marked ischemic lesions in 5 cases and moderate lesions in 3 cases. These pathological findings tended to be more remarkable in the cases, in which main feeders had been occluded completely and the reduction of contrast enhancement had been shown on CT scanning. The pathological evaluation of the tumors suggests the possibility of hemorrhage within and around the tumors after embolization. The results of embolization evaluated on the basis of operative findings were effective in 10 cases.
From this study, it was concluded that embolization of the intracranial meningiomas can facilitate the surgery by reducing the great risk of hemorrhage during operation, and that surgical excision of the tumor should be performed as early as possible after embolization.
