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Nam Yoon of the Institute of Clinical Neuroscience at the University of Utah in the United States reviewed the literature to examine the adaptation evidence of pre-cranial meninges and the adaptation of pre-cranial embolism blood supply, as well as related techniques and effectsThe article was published in the April 2018 issue of Neurorfocus- From the article chapter(Ref: "Ref: Yoon N, et alNeurosurg Focus2018 Apr;44"4):E5.doi: 10.3171/2018.1.FOCUS17686.
because of the abundance and complexity of blood supply of cranioblastoma, preoperative embolism supply is conducive to the reduction of hemangiohacic hemorrhage and tumor removal, but lacks clinical research guidanceNam Yoon of the Institute of Clinical Neuroscience at the University of Utah in the United States reviewed the literature to examine the adaptation evidence of pre-cranial meninges and the adaptation of pre-cranial embolism blood supply, as well as related techniques and effectsThe article was published in the April 2018 issue of Neurorfocusthe choice of pre-cranial meningioma for blood embolism depends largely on the neurosurgeon's personal preferencesLatchaw and others suggest preoperative embolism:blood-borne blood vessels are complex, severe tumor-peripheral edema affects the identification boundary during surgery, tumor proximity to the functional area, and icommy, scalp and skullWaldron and others proposed exclusion criteria, such as tumor-surrounding vascular diseases and the history of strokethe vascular embolism agentcurrent currently in use has its advantages and disadvantagesThe success rate of embolism was 80%-100% and the total complication incidence was 0%-20%Solid embolism agent, polyvinyl alcohol (PVA) particles in the water expansion, injected into the blood vessels to produce an inflammatory reaction, resulting in blood clot formation, so PVA is an effective embolism agentThe incidence of embolism complications was significantly reduced in the PVA large particles of 150-250um compared to the small particles of 45-50um (OR?10.2; 95% CI, 1.3-80.7; p.028) Solid embolism agent, microsphere size, shape uniform and compressible, has better biomechanical properties Microspheres can be temporarily compressed by 33%, allowing for smooth passage through the catheter and transport After release, the microsphere reverts to its original diameter, resulting in a durable embolism Studies have reported that 55 cases of meningioma have been embolated by 400um microspheres without complications cyanopropylate (NBCA) is a liquid glue that has a lower risk of brain haemorrhage or ischemic complications when used in blood vessels The NBCA can be pushed further into the target blood vessel by simultaneously injecting 5% of the right-hand glycosic acid through the catheter Compared to solid particles, the use of liquid embolism reduces the risk of intracranial bleeding Onyx is a ethylene-vinyl compound that penetrates deeply in the blood vessels of the tumor and can be stopped intermittently during operation compared to other liquid preparations However, there are currently fewer reports of Onyx embolism Fusco and other 4 patients treated with Onyx embolism, the success rate of 100%, no complications microcatheters for intravascular embolism have been greatly improved to make embolism safer At the far end of cerebrovascular vessels, the non-lead blood flow-oriented catheter reduces the risk of cerebral hemorrhage and vascular damage, but the catheter cannot accurately select the target blood vessel under blood flow guidance When using NBCA, the tip of the catheter should reach as far as possible into the blood vessels, and Onyx requires the catheter to go deeper Another development in microcatheters is the design of separable tips For example, Apollo microcatheters are highly flexible and tip-to-use, and when using Onyx or NBCA embolisms, they are desirable and do not occur with complications directly related to microcatheters precranial meningioma is a fickle and complex blood supply The main blood supply arteries for 13% of the front cranial hypothalamus is the sieve front artery or the sieve arteries (AEA/PEA) The blood supply for the cerebrmenal membrane of the olfactory and butterfly platforms can come from the epidural, bone, and even the soft membrane The arteries (MMA) in the meninges supply about 17% of the cerebellum meningioma The tumor at the base of the skull can be fed by the mmA front branch of the upper cranial branch, the eye artery (OphA) meninges return branch and the tear sac artery (Figure 1), the intra-cervical artery (ICA) meninges branch, the meninge pituitary stem (MHT) cerebellum branch, the front branch of the lower outer stem (ILT) and the end end of the interstitial artery (IMA) to provide blood Therefore, the blood supply of the precranial meningioma is very rich (Figure 2) Waldron et al were completely successful lymbolations in 55 cases of pre-cranial and mid-cranial meningiomas Early blocking of AEA/PEA blood supply reduces blood loss to help tumor removal, but arterial wall thickness is often buried deep in the growthof hardened bone holes, early blocking is very difficult Blood-donor arteries such as intravascular embolism can cause serious complications, such as blindness due to misemposing OphA, and care must be taken Figure 1 44-year-old female, right butterfly bone membrane membrane tumor imaging showed that blood was supplied mainly by the Return of The OphA meninges Identifying this main blood supply artery is very helpful in surgery, and the early eradication of the vascular base can reduce the difficulty of tumor removal A.MRI-T1 weighted enhanced imaging shows that the tumor size 4.6 x 5.4 cm, B Right outer neck artery (ECA) contrast did not show tumor staining, C, D right end of the neck artery (ICA) contrast front and rear (C) and side (D) show a large OphA meninges return branch, is the main artery supply of tumor figure 2 67-year-old male with a membrane tumor on the right side of the butterfly bone blood supply arteries come from ICA and ECA According to the DSA results, onyx embolism on the right MMA was performed and tumor staining was significantly reduced A.MRI-T1 weighted enhanced imaging shows that the tumor size is 5.4 x 3.6 cm, B Right ECA contrast shows blood supply from MMA and AEA or PEA arteries, C, D right-hand ICA after contrast (C) side position (D) shows a small amount of tumor staining, arterial supply from OphA branch and small soft membrane branch the rock oblique meningioma at the bottom of the skull originated in two-thirds of the upper and middle slopes, and was deep in place, and full excision was challenging Blood-donor blood vessels from the opposite side make it difficult for early tumors to go to the blood supply, the dual blood supply of ICA and ECA also increases the difficulty of intravascular embolism, and intravascular embolism can also lead to complications such as cranial nerve paralysis and urinary collapse In the process of side ICA imaging, it is often seen that the tumor is obviously dyed, and there are often matching branches across the middle line between the two-sided ICA ECA blood supply can be derived from MMA, IMA and pharynx arteries The meningioma in the pillow-hole area is located in the lower third of the slope and supplies blood vessels that are intricate and can be supplied with blood from the vertebral artery (VA) and the lower end of the celiac, the lower part of the cerebellum and the post-spinal artery, so the risk of preoperative embolism is high finally the authors point out that the anatomy and blood supply of cranial meningiomas is complex, and that although preoperative embolism can be used as an surgical aid, complex and variable supply arteries are challenging for safe embolism therefore, in order to avoid serious complications resulting in disability or death, it is recommended to advocate a conservative approach and not to actively block blood supply with preoperative intravascular embolism.