Hypervascular tumorに対するNBCAによる術前塞栓術の有用性

The Utility and Efficacy of Preoperative Embolization for Hypervascular Tumor by NBCA

Ⅰ．はじめに

　頭蓋内hypervascular tumorの術前塞栓術には，粒状塞栓物質が主に使用されてきたが，近年，液状塞栓物質の使用の報告が散見される．しかしながら，その報告例は少なく^6,8,9)，その有用性やpitfallなどについて十分議論されているとは言い難い．そこで，今回これまで当科で，n-butyl 2-cyanoacrylate（NBCA）を用いた術前塞栓術を施行した頭蓋内腫瘍に加え，頭頚部や椎体のhypervascular tumorについても検討範囲を広げ，適応や留意点について検討した．

　Preoperative embolization for hypervascular tumors is typically performed using particle agents such as polyvinyl alcohol,gelfoam powder,and fibrin glue. Furthermore,n-butyl-2-cyanoacrylate (NBCA) is used in patients with cerebral arteriovenous malformation (AVM) or an AV shunt. However,few reports have described the efficacy of NBCA in treating hypervascular tumors. Here,we report cases of hypervascular tumors in which preoperative embolization was performed using NBCA. We also discuss the difference between the efficacy of a liquid agent and a particle agent for hypervascular tumor embolization.

　We analyzed 10 cases encountered at our institution since 2004 in which preoperative embolization was performed using NBCA. In all cases,NBCA was injected through the tumor-feeding artery. In eight of these cases,preoperative embolization decreased intraoperative bleeding and markedly reduced the tumor stain. In the remaining two cases,complications occurred but without any permanent sequel. Thus,NBCA is useful for preoperative embolization.