BackgroundMeningiomas are often embolized preoperatively to reduce intraoperative blood loss and facilitate tumor resection. However, the procedure is controversial and its effects have not yet been reported. We evaluated preoperative embolization for meningiomas and its effect on postoperative outcome and recurrence.MethodsWe retrospectively reviewed the medical records of 186 patients with WHO grade I meningiomas who underwent surgical treatment at our hospital between January 2010 and December 2020. We used propensity score matching to generate embolization and no-embolization groups (42 patients each) to examine embolization effects.ResultsPreoperative embolization was performed in 71 patients (38.2%). In the propensity-matched analysis, the embolization group showed favorable recurrence-free survival (RFS) (mean 49.4 vs 24.1 months; Wilcoxon p=0.049). The embolization group had significantly less intraoperative blood loss (178±203 mL vs 221±165 mL; p=0.009) and shorter operation time (5.6±2.0 hours vs 6.8±2.8 hours; p=0.036). There were no significant differences in Simpson grade IV resection (33.3% vs 28.6%; p=0.637) or overall perioperative complications (21.4% vs 11.9%; p=0.241). Tumor embolization prolonged RFS in a subanalysis of cases who experienced recurrence (n=39) among the overall cases before variable control (mean RFS 33.2 vs 16.0 months; log-rank p=0.003).ConclusionsAfter controlling for variables, preoperative embolization for meningioma did not improve the Simpson grade or patient outcomes. However, it might have effects outside of surgical outcomes by prolonging RFS without increasing complications.
A3-A3 side-to-side bypass (A3-A3 bypass) is commonly used for revascularization of the anterior cerebral artery territory; however, it is indicated in few patients. This study investigated the indications for A3-A3 bypass based on our clinical experience and a literature review. The study included 5 patients (3 men and 2 women) who underwent A3-A3 bypass between April 2012 and November 2017. The patients were in their 20s (n = 2), 40s (n = 1), and 50s (n = 2). The diagnoses included unruptured anterior communicating artery aneurysm treated with trapping (n = 1), recurrent enlargement of the anterior communicating artery after clipping (n = 1), anterior cerebral artery dissection (n = 1), anterior cerebral artery stenosis with cerebral infarction (n = 1), and traumatic distal anterior cerebral artery aneurysm (n = 1). A3-A3 bypass was completed and patency was confirmed in all patients. The requirements for A3-A3 bypass performance include suturing skills for anastomosis, appropriate selection of donor and recipient vessels, and comprehensive preoperative assessment. The indications for A3-A3 bypass are various. When performing a craniotomy for anterior communicating artery aneurysms and distal anterior cerebral artery aneurysms, the A3-A3 bypass can be used as a rescue technique. Therefore, stroke surgeons should master the essential skills. Training in suturing skills is an important part of preparation for the procedure.
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