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Neurological Surgery No Shinkei Geka Volume 44, Issue 7 （July 2016）

Neurological Surgery 脳神経外科 44巻7号（2016年7月発行）

Japanese English

研究

髄膜腫の術前塞栓の有用性—エンボスフィア^®の使用経験 Efficiency of Embosphere in the Pre-Operative Embolization of Meningioma:Clinical Experience 下田祐介 ¹ , 長内俊也 ¹ , 寺坂俊介 ¹ , 小林浩之 ¹ , 山口秀 ¹ , 遠藤将吾 ¹ , 畑中佳奈子 ² , 寳金清博 ¹ Yusuke SHIMODA ¹ , Toshiya OSANAI ¹ , Syunsuke TERASAKA ¹ , Hiroyuki KOBAYASHI ¹ , Shigeru YAMAGUCHI ¹ , Shogo ENDO ¹ , Kanako HATANAKA ² , Kiyohiro HOUKIN ¹ ¹北海道大学病院脳神経外科 ²北海道大学病院病理診断科 ¹Department of Neurosurgery, Hokkaido University Hospital ²Department of Surgical Pathology, Hokkaido University Hospital キーワード： Embosphere , meningioma , embolization , pre-operative embolization , necrosis Keyword: Embosphere , meningioma , embolization , pre-operative embolization , necrosis pp.555-560

発行日 2016年7月10日 Published Date 2016/7/10

DOI https://doi.org/10.11477/mf.1436203330

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Ⅰ．はじめに

　2014年1月，本邦で脳神経領域の動脈塞栓術においてエンボスフィア^®（日本化薬，東京）の使用が保険適用となった．ゼラチンでコーティングされたアクリル系共重合体からなる非吸水性マイクロスフィアで，今後塞栓物質の中心的な役割を担うと考えられている．当施設では巨大な髄膜腫の摘出術前に塞栓術を実施しており，今回，エンボスフィア^®を用いた塞栓術後の初期成績について検討したため報告する．

　Embosphere^® was approved in Japan for embolizing intracranial arteries for the reduction of intraoperative bleeding in January 2014. Until August 2015, we performed embolization for four meningiomas using Embosphere^®. We performed an initial evaluation of all the cases, including evaluation of the clinical courses, change in the maximum tumor diameters and volumes, alteration in the appearance on magnetic resonance imaging（MRI), amount of intraoperative bleeding, complications, and histopathological findings. After embolization, the maximum tumor diameters and volumes slightly decreased on MRI, whereas the signal change on diffusion-weighted imaging（DWI）or fluid-attenuated inversion recovery（FLAIR）varied in each case. One case demonstrated a partial signal change on DWI one day after the initial procedure, and another case demonstrated a decrease in perifocal edema on FLAIR. Among our patients, least bleeding was recorded at 6 days after the embolization. Histopathological analysis revealed coagulative necrotic lesions in two cases. The von Kossa stain was used to distinguish Embosphere^® from the psammoma body. One case involved a thromboembolic complication of the retinocentral artery caused by an Embosphere^® of 100-300 μm. Our early-stage experience suggests that an Embosphere^® of 300-500 μm should be used for safe embolization before resection to avoid thromboembolic complications because an Embosphere^® of 100-300 μm can pass through the dangerous anastomosis. Our present strategy was to resect the tumor approximately seven days after the embolization using Embosphere^®. However, further studies and discussion on the size of Embosphere^®, and the interval between pre-operative embolization and surgical removal are needed.