髄膜腫に対する血管内腫瘍塞栓術

Preoperative Embolization of Intracranial Meningioma

Point

・大型や頭蓋底部髄膜腫に対する術前塞栓術は，開頭術の補助的手術として有用である．

・開頭術者と十分な術前検討を行った上で，戦略的な塞栓術を行うことが肝要である．

・目的に応じた塞栓物質を選択し，合併症を起こさない塞栓術を心掛ける．

　Preoperative embolization（POE）of intracranial meningioma is performed worldwide. Although clear evidence of the effectiveness of POE has not been reported in the literature, the technique plays an important role in open surgery, especially for large or skull base meningiomas. The purposes of embolization include: 1）induction of tumor necrosis, resulting in a safer operation, 2）reduction in intraoperative bleeding, and 3）decrease in operative time. Knowledge of the functional vascular anatomy, embolic materials, and endovascular techniques is paramount to ensure safe embolization.

　Our standard procedure is as follows: 1）embolization is performed several days before open surgery; 2）in cases with strong peritumoral edema, steroid administration or embolization may be performed immediately prior to surgery; 3）patients undergo the procedure under local anesthesia; 4）the microcatheter is inserted as close as possible to the tumor; 5）particulate emboli are the first-line material; 6）embolization is occasionally performed with N-butyl cyanoacrylate（NBCA）glue; and 7）if possible, additional proximal feeder occlusion with coils is performed.

　The JR-NET study previous showed the situation regarding intracranial tumor embolization in Japan.

　Endovascular neurosurgeons should fully discuss the indications and strategies for POE with tumor neurosurgeons to ensure safe and effective procedures.