Infiltrated Embolization of Meningioma with Dilute Cyanoacrylate Glue
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- OHNISHI Hiroyuki
- Department of Neurosurgery Neuroendovascular Surgery, Osaka Medical College Department of Neurosurgery, Eimeikai Ohnishi Neurological Center
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- MIYACHI Shigeru
- Department of Neurosurgery Neuroendovascular Surgery, Osaka Medical College
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- MURAO Kenichi
- Department of Neuroendovascular Therapy, Shunjukai Shiroyama Hospital
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- HIRAMATSU Ryo
- Department of Neurosurgery Neuroendovascular Surgery, Osaka Medical College
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- TAKAHASHI Kenkichi
- Department of Neurosurgery, Eimeikai Ohnishi Neurological Center
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- OHNISHI Hideyuki
- Department of Neurosurgery, Eimeikai Ohnishi Neurological Center
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- KUROIWA Toshihiko
- Department of Neurosurgery Neuroendovascular Surgery, Osaka Medical College
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抄録
<p>We describe the efficacy and technical aspects of infiltrated preoperative embolization of meningioma by penetration of very dilute glue. In this method, a 13% n-butyl-cyanoacrylate (NBCA)-lipiodol mixture is injected extremely slowly from the middle meningeal artery (MMA) in a similar manner to plug and push injection of ethylene vinyl alcohol copolymer mixed with tantalum and dimethyl sulfoxide (Onyx®) after the tortuous side feeders are proximally embolized. The glue is infiltrated into small tumor arteries and extends to inaccessible feeders from deep meningeal arteries. Since 2011, we have used this technique in the embolization of 32 cases preoperatively diagnosed with meningioma. Intratumoral embolization was possible in 30 cases (94%), and a greater than 50% reduction in contrast area of contrast-enhanced T1-weighted MR imaging (T1-WI) was achieved in 18 cases (56%). Two cases achieved complete devascularization, showing a remarkable shrinkage in tumor size after embolization. If excessive reflux of embolization and the resulting migration of glue into normal arteries is achieved, this method provides extremely effective devascularization on surgical extirpation. It might also be applicable to surgically untreatable meningiomas as a semi-radical treatment option.</p>
収録刊行物
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- Neurologia medico-chirurgica
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Neurologia medico-chirurgica 57 (1), 44-50, 2017
一般社団法人 日本脳神経外科学会