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Abstract：
Introduction Preoperative embolization can potentially facilitate surgical resection of challenging tumors in the intracranial and facial regions; however, its clinical efficacy remains controversial, mainly due to potential morbidity risks. We explored negative factors of the combined treatment of preoperative embolization and tumor resection that affect neurological prognosis. Method This retrospective study used clinical data from 132 consecutive tumors that underwent combined treatment at multiple facilities between January 2016 and May 2021. Basic patient information, tumor characteristics, and treatment details were assessed to identify predictors of deterioration as measured using the modified Rankin scale (mRS) score at three months post-treatment. Results Among the 126 eligible combined treatments, a deterioration in the postoperative mRS score was observed in 19/126 (15.1%). Complications related to embolization and tumor resection occurred in 8/126 (6.3%) and 19/125 (15.2%) of procedures, respectively. Multivariate analyses indicated significant associations between migration of embolic material (adjusted odds ratio 13.80; 95% confidence interval 1.25-152.52; p=0.03), elevated intraoperative blood loss (p=0.04), and deterioration of postoperative mRS score. Embolic material migration was identified as the primary prognostic factor for the deterioration of score. An analysis of 192 procedures, excluding those that exclusively used coils, identified embolization targeting the accessory meningeal artery (p=0.046) and the third segment of the internal maxillary artery (p=0.03) as a risk factor for embolic material migration. Conclusions Embolic material migration is the predominant factor associated with declining neurological outcome that persists into the chronic phase after combined treatment. Given that preoperative embolization is a supplementary treatment option, a thorough understanding of vascular anatomy and striving safe procedure are critical.
摘要：
引言术前栓塞可能有助于手术切除颅内和面部区域的挑战性肿瘤；然而，其临床疗效仍存在争议，主要是由于潜在的发病风险。我们探讨了术前栓塞和肿瘤切除联合治疗影响神经系统预后的不利因素。方法这项回顾性研究使用了2016年1月至2021年5月在多个机构接受联合治疗的132例连续肿瘤的临床数据。患者基本信息,肿瘤特征，和治疗细节进行评估,以确定治疗后3个月使用改良Rankin量表(mRS)评分测量的恶化预测因子.结果在126个符合条件的联合治疗中，在19/126(15.1%)中观察到术后mRS评分恶化.与栓塞和肿瘤切除相关的并发症发生在8/126(6.3%)和19/125(15.2%)的手术中，分别。多变量分析表明，栓塞材料的迁移之间存在显着关联（调整后的比值比13.80；95％置信区间1.25-152.52；p=0.03），术中失血量升高（p=0.04），术后mRS评分恶化。栓塞材料迁移被确定为评分恶化的主要预后因素。对192个程序的分析，不包括那些专门使用线圈的，确定针对副脑膜动脉（p=0.046）和上颌内动脉第三段（p=0.03）的栓塞是栓塞材料迁移的危险因素。结论：栓塞性物质迁移是联合治疗后持续到慢性期的神经系统预后下降的主要因素。鉴于术前栓塞是一种补充治疗选择，彻底了解血管解剖结构和确保安全的手术至关重要。
