oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences10.21294/1814-4861-2025-24-2-150-161oncotomsk-3547Research ArticleОБЗОРЫREVIEWSРиски эмболизационных технологий в хирургии доброкачественных и злокачественных опухолей основания черепаRole of embolization in surgery for skull base tumorshttps://orcid.org/0000-0002-5509-5612ГуляевД. А.GulyaevD. A.

Гуляев Дмитрий Александрович, доктор медицинских наук, профессор, главный научный сотрудник НИЛ интегративных нейрохирургических технологий; руководитель научного отделения нейроонкологии и эндоскопии

197758, г Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

197341, г Санкт-Петербург, ул. Аккуратова, 2

Dmitry A. Gulyaev, MD, DSc, Professor, Chief Researcher, Laboratory of Integrative Neurosurgical Technologies; Head of the Department of Neuro-oncology and Endoscopy

68, Leningradskaya St., Pesochny village, Saint Petersburg, 197758 

2, Akkuratova St., Saint Petersburg, 197341 

https://orcid.org/0000-0003-2473-2671БеловИ. Ю.BelovI. Yu.

Белов Игорь Юрьевич, кандидат медицинских наук, нейрохирург; старший научный сотрудник научного отделения нейроонкологии и эндоскопии

197758, г Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

197341, г Санкт-Петербург, ул. Аккуратова, 2

Igor Yu. Belov, MD, PhD, Neurosurgeon; Senior Researcher, Department of Neuro-oncology and Endoscopy

68, Leningradskaya St., Pesochny village, Saint Petersburg, 197758 

2, Akkuratova St., Saint Petersburg, 197341 

https://orcid.org/0000-0003-2857-8368КурносовИ. А.KurnosovI. A.

Курносов Иван Александрович, заведующий отделением нейроонкологии, младший научный сотрудник научного отделения нейроонкологии и эндоскопии

197758, г Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

Ivan A. Kurnosov, MD, Head of Neuro-oncology Department, Junior Researcher, Department of Neuro-oncology and Endoscopy 

68, Leningradskaya St., Pesochny village, Saint Petersburg, 197758 

ivkurnosov@gmail.comhttps://orcid.org/0000-0002-7443-0500ЧижоваК. А.ChizhovaK. A.

Чижова Ксения Александровна, клинический ординатор 

197341, г Санкт-Петербург, ул. Аккуратова, 2

Kseniya A. Chizhova, MD, Clinical Resident 

2, Akkuratova St., Saint Petersburg, 197341 

https://orcid.org/0000-0002-6138-3055СамочерныхН. К.SamochernykhN. K.

Самочерных Никита Константинович, аспирант кафедры нейрохирургии 

197341, г Санкт-Петербург, ул. Аккуратова, 2

Nikita K. Samochernykh, MD, Postgraduate, Department of Neurosurgery

2, Akkuratova St., Saint Petersburg, 197341 

https://orcid.org/0000-0002-3042-6729БалахнинП. В.BalakhninP. V.

Балахнин Павел Васильевич, кандидат медицинских наук, старший научный сотрудник научного отделения диагностической и интервенционной радиологии, заведующий отделением рентгенохирургических методов диагностики и лечения

197758, г Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

Pavel V. Balakhnin, MD, PhD, Senior Researcher, Department of Diagnostic and Interventional Radiology, Head of X-ray Surgical Diagnostics and Treatment Department

68, Leningradskaya St., Pesochny village, Saint Petersburg, 197758 

ФГБУ «НМИЦ онкологии им. Н.Н. Петрова» Минздрава России ; ФГБУ «НМИЦ им. В.А. Алмазова» Минздрава РоссииРоссияN.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of Russia ; V.A. Almazov National Medical Research Center of the Ministry of Health of RussiaRussian FederationФГБУ «НМИЦ онкологии им. Н.Н. Петрова» Минздрава РоссииРоссияN.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of RussiaRussian FederationФГБУ «НМИЦ им. В.А. Алмазова» Минздрава РоссииРоссияV.A. Almazov National Medical Research Center of the Ministry of Health of RussiaRussian Federation202517052025242150161Copyright © Гуляев Д.А., Белов И.Ю., Курносов И.А., Чижова К.А., Самочерных Н.К., Балахнин П.В., 20252025Гуляев Д.А., Белов И.Ю., Курносов И.А., Чижова К.А., Самочерных Н.К., Балахнин П.В.Gulyaev D.A., Belov I.Y., Kurnosov I.A., Chizhova K.A., Samochernykh N.K., Balakhnin P.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/3547

Цель исследования - обобщить мировой и собственный опыт применения эмболизационных технологий в хирургии доброкачественных и злокачественных опухолей основания черепа, детально проанализировав связанные с ними риски и осложнения для совершенствования подходов к лечению и минимизации негативных последствий. Материал и методы. Проведен анализ научных публикаций, найденных в международных медицинских базах данных (PubMed, Cochrane Library, Elibrary и др.), охватывающих исследования за последние 20 лет, а также ретроспективный анализ собственного клинического материала с применением эмболизационных методов у пациентов с опухолями основания черепа. Изучены особенности и специфика эмболизационных техник, применяемые материалы и критерии оценки осложнений, включая классификации, разработанные международными экспертными сообществами. Результаты. Анализ показал, что результаты применения эмболизационных технологий в лечении опухолей основания черепа остаются противоречивыми, а спектр осложнений варьирует от незначительных реакций до тяжелых и инвалидизирующих состояний. Среди наиболее серьезных осложнений выявлены инсульт, нарушения функции черепных нервов, некроз тканей и летальные исходы. Важным аспектом является определение оптимального временного интервала между эмболизацией и последующей хирургической резекцией, т. к. слишком раннее вмешательство не позволяет в полной мере реализовать потенциал эмболизации, а отсроченное ведет к риску реканализации и нарастанию перифокального отека с прогрессированием неврологического дефицита. Особое внимание уделено постэмболизационному неврологическому синдрому (PENS), способному вызывать стойкие и необратимые неврологические нарушения. Заключение. Несмотря на потенциальные преимущества в снижении интраоперационной кровопотери и облегчении хирургического вмешательства, использование эмболизационных технологий требует тщательного анализа и оценки возможных рисков и осложнений. Решение о применении эмболизации должно быть строго индивидуальным и опираться на междисциплинарный подход с учетом особенностей каждого клинического случая.

Objective: to summarize global and personal experience in the application of embolization techniques in the surgical management of benign and malignant skull base tumors, comprehensively analyzing associated risks and complications to improve treatment approaches and minimize negative outcomes. Material and Methods. An analysis of scientific publications from international medical databases (PubMed, Cochrane Library, Elibrary and others) covering studies over the past 20 years, as well as a retrospective analysis of our own clinical data on embolization for skull base tumors was conducted. Specific details and features of embolization techniques, materials used, and criteria for complication assessment, including classifications developed by international expert societies, were thoroughly examined. Results. The analysis revealed that outcomes from embolization techniques in skull base tumor surgery remain controversial, with a wide range of complications from minor reactions to severe and disabling conditions. Major complications identified included stroke, cranial nerve dysfunction, tissue necrosis, and death. Determination of the optimal timing interval between embolization and subsequent surgical resection is critical, as premature surgery does not fully exploit embolization potential, whereas delayed surgery increases the risk of recanalization and progression of perifocal edema, exacerbating neurological deficits. Particular attention was given to the postembolization neurological syndrome (PENS), which may result in persistent and irreversible neurological impairment. Conclusion. Despite potential benefits in reducing intraoperative blood loss and facilitating surgical procedures, the use of embolization technologies requires careful evaluation of risks and potential complications. Decisions regarding embolization should be individualized and based on a multidisciplinary approach considering the specifics of each clinical case.

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The authors declare that there are no conflicts of interest present.