栓塞物质迁移是结合瘤切除和手术前栓塞后预后恶化的主要因素
Ryosuke Suzuki1, Taisuke Akimoto1, Shigeta Miyake2
1Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, JPN.
Cureus
|May 1, 2024
概括
脑瘤手术前栓塞期间的栓塞物质迁移显著恶化了神经系统的结果. 了解血管解剖学和确保程序安全对于改善结合栓塞和切除后患者预后至关重要.
科学领域:
- 神经外科 神经外科
- 干预性放射学 干预性放射学
- 血管外科 血管外科
背景情况:
- 术前栓塞用于复杂的内和面部瘤,但由于潜在的风险,其益处受到争议.
- 结合栓塞和瘤切除后的神经预后可能会受到负面因素的影响.
- 确定神经系统恶化的预测因素对于优化治疗策略至关重要.
研究的目的:
- 探索影响神经预后的负面因素,在经过联合手术前栓塞和瘤切除的患者.
- 通过修改的兰金尺度 (mRS) 评分来识别神经系统恶化的预测因素.
主要方法:
- 在2016年1月至2021年5月期间连续治疗的132种瘤的回顾性研究.
- 分析患者信息,瘤特征和治疗细节.
- 多变量分析以确定mRS得分在治疗后三个月恶化的预测因素.
主要成果:
- 在符合条件的治疗中,术后mRS得分的恶化发生在15.1%的患者 (19/126).
- 栓塞性物质迁移 (OR 13.80) 和高的手术内流血是mRS得分恶化的显著预测因素.
- 针对辅助脑膜动脉和内动脉的第三段被确定为栓塞物质迁移的风险因素.
结论:
- 栓塞性物质迁移是联合治疗后神经结果下降的主要因素.
- 术前栓塞需要对血管解剖学的全面了解,并专注于程序安全.
- 尽量减少栓塞物质迁移对于改善患者进行栓塞和瘤切除的长期神经学预后至关重要.
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