Staged surgical treatment of a hypervascular cerebellar hemangioblastoma and saccular superior cerebellar artery aneurysm using preoperative embolization with a low viscosity non-adhesive liquid embolic agent

Abstract Introduction: Preoperative transarterial embolization (TAE) for hemangioblastoma carries a risk of cerebral infarction and hemorrhagic complications, and its safety and efficacy are controversial. Method: Twenty-two cases of hemangioblastoma (cerebellar: 18 cases, medulla oblongata: 3 cases, spinal cord: 1 case) treated via direct surgery in our hospital from 2007 to 2020 were enrolled. Results: Preoperative TAE was performed in 6 cases of cerebellar hemangioblastoma (1 bilateral case) and 1 case of spinal hemangioblastoma. The cerebellar hemangioblastoma feeders were only superior cerebellar artery (SCA) in 3 cases, SCA/anterior inferior cerebellar artery (AICA)/posterior inferior cerebellar artery (PICA) in 2 cases, AICA/PICA in 1 case, and single drainer in 5 cases. Tumors were ≥30 mm in all cases (25 mm on 1 side in bilateral cases), and solid or nodular lesions were located on the upper surface of the cerebellum. Cerebellar edema was severe in five cases with hydrocephalus. TAE was performed under local anesthesia in all cases, using a coil alone in two cases and liquid or particle embolization material in five cases. The day before direct surgery, TAE was performed in four cases, one of which underwent emergency decompression due to severe cerebellar edema. Three cases were intentionally embolized on the day of direct surgery. The median blood loss during direct surgery was 100 ml. Although cerebral infarction was observed in all cases, there were no cases of brain stem infarction or hemorrhagic complications. The Modified Rankin Scale at discharge was 0 in 2 cases, 1 in 3 cases, 3 in 1 case, and 4 in 1 case. Discussion/Conclusion: Preoperative TAE for hemangioblastoma reduced the blood loss for direct surgery. Same-day TAE avoided neurological deficit due to cerebral infarction and cerebellar edema. To prevent severe infarction, guiding the microcatheter to the vicinity of the tumor bed is important.

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Embolization of a Renal Artery Aneurysm Using Ethylene Vinyl Alcohol Copolymer (Onyx)

Journal of Endovascular Therapy ◽

10.1177/152660280301000232 ◽

2003 ◽

Vol 10 (2) ◽

pp. 366-370 ◽

Cited By ~ 3

Author(s):

Tommaso Lupattelli ◽

Ziyad Abubacker ◽

Robert Morgan ◽

Anna-Maria Belli

Keyword(s):

Renal Artery ◽

Artery Aneurysm ◽

Ease Of Use ◽

Embolic Agent ◽

Renal Artery Aneurysm ◽

Parent Vessel ◽

Embolic Material ◽

Ethylene Vinyl Alcohol ◽

Liquid Embolic ◽

Liquid Embolic Agent

Purpose: To report the embolization of a renal artery aneurysm using Onyx, a radiopaque nonadhesive liquid embolic agent. Case Report: A 28-year-old woman with hypertension and fibromuscular dysplasia presented with a 20-mm renal artery aneurysm. In order to avoid any migration of embolic material into the parent vessel, a compliant balloon was inflated to exclude the aneurysm from the blood flow while injecting the liquid embolic agent. Complete aneurysm exclusion was achieved immediately, with no angiographic or duplex evidence of distal embolization or intra-aneurysmal flow. The Doppler ultrasound at 6 months confirmed aneurysm exclusion. Conclusions: The ease of use and nature of this material makes Onyx an effective and safe option in the treatment of wide-necked renal aneurysms.

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Surgical Treatment of A Dissecting Aneurysm of the Superior Cerebellar Artery: Case Report

Romanian Neurosurgery ◽

10.2478/romneu-2014-0036 ◽

2014 ◽

Vol 21 (3) ◽

pp. 269-273 ◽

Cited By ~ 1

Author(s):

Florin Stefanescu ◽

Stefanita Dima ◽

Mugurel Petrinel Radoi

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Endovascular Treatment ◽

Artery Aneurysm ◽

Peripheral Region ◽

Dissecting Aneurysm ◽

Superior Cerebellar Artery ◽

Surgical Clipping ◽

Cerebellar Artery

Abstract Dissecting aneurysm located in the peripheral region of the superior cerebellar artery is very rare. There is little experience regarding their surgical or endovascular treatment. We present the case of a peripheral dissecting superior cerebellar artery aneurysm treated by surgical clipping.

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Embolization with onyx liquid embolic agent of a ruptured splenic artery aneurysm

Resuscitation ◽

10.1016/j.resuscitation.2010.09.348 ◽

2010 ◽

Vol 81 (2) ◽

pp. S85

Author(s):

M. Jarauta Francisco Javier ◽

J.-L. Clint ◽

I. Insausti ◽

T. Belzunegui ◽

F. Urtasun

Keyword(s):

Splenic Artery ◽

Artery Aneurysm ◽

Splenic Artery Aneurysm ◽

Embolic Agent ◽

Liquid Embolic ◽

Liquid Embolic Agent

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A Nonadhesive Liquid Embolic Agent of Ethylene Vinyl Alcohol Copolymer and Ethanol Mixture for Cerebral Arteriovenous Malformations

Interventional Neuroradiology ◽

10.1177/15910199040100s123 ◽

2004 ◽

Vol 10 (1_suppl) ◽

pp. 135-142 ◽

Cited By ~ 4

Author(s):

JI Hamada ◽

Y. Kai ◽

T. Mizuno ◽

M. Morioka ◽

K. Kazekawa ◽

...

Keyword(s):

Vinyl Alcohol ◽

Arteriovenous Malformations ◽

Neurological Deficits ◽

Embolic Agent ◽

Preoperative Embolization ◽

Ethanol Mixture ◽

Ethylene Vinyl Alcohol ◽

Ethylene Vinyl Alcohol Copolymer ◽

Liquid Embolic ◽

Liquid Embolic Agent

We report our experience using our new nonadhesive liquid embolic agent, an ethylene vinyl alcohol copolymer (EVAL)/Ethanol mixture, to treat human arteriovenous malformations (AVM). Between June 1995 and April 2001, 57 patients with confirmed AVM underwent embolization with the EVAL/Ethanol mixture. Using 87 procedures consisting of one to three stages, we embolized 185 feeding arteries to occlude as much of the AVM as possible. Repeated injections under fluoroscopic control could be performed smoothly without encountering cementing of the catheter in the vessel wall. Among 87 procedures undertaken in 57 patients, seven (8.0%) procedures in six patients produced new postembolization symptoms. Resolution of these symptoms occurred within hours or days following four of the seven procedures; permanent neurological deficits remained after three embolization procedures (3.4%). Of the 57 patients, three underwent postembolization radiosurgery, 54 were radically treated with microsurgical extirpation. Histopathological examinations of the 54 specimens disclosed mild inflammation within the embolized lumen without inflammatory reactions in the media or adventitia. Follow-up angiograms obtained three years after they underwent radiosurgery showed that in all three patients the nidus had completely disappeared. The EVAL/Ethanol mixture is handled easily and appears to be an effective and safe embolic agent for the preoperative embolization of AVM.

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Superficial temporal artery-superior cerebellar artery bypass and direct clipping of a large unruptured superior cerebellar artery aneurysm through subtemporal approach: Surgical video

Surgical Neurology International ◽

10.25259/sni_460_2019 ◽

2019 ◽

Vol 10 ◽

pp. 225

Author(s):

Jiangyu Xue ◽

Hugo Andrade-Barazarte ◽

Gangqin Xu ◽

Dongyang Cai ◽

Yang Bowen ◽

...

Keyword(s):

Blood Flow ◽

Surgical Treatment ◽

Artery Bypass ◽

Superficial Temporal Artery ◽

Artery Aneurysm ◽

Temporal Artery ◽

Superior Cerebellar Artery ◽

Parent Artery ◽

Subtemporal Approach ◽

Cerebellar Artery

Background: Superior cerebellar artery (SCA) aneurysms are rare. Current treatments include: direct clipping, trapping ± bypass, and endovascular methods (coiling, stenting, or flow diversion). Due to specific characteristics (wide base, location, and shape), a major challenge while dealing with SCA aneurysms is to preserve the flow of the parent artery and perforators. This video demonstrates a revascularization procedure, and clip reconstruction of a large unruptured basilar artery (BA)/SCA aneurysm performed through the subtemporal approach. Case Description: A 60-year-old woman presented with dizziness and headaches. Computed tomography angiography (CTA) and digital subtraction angiography showed a right unruptured large BA/SCA aneurysm. After multidisciplinary discussion, and considering gender, age, risk factors of the patient. Endovascular treatment was considered with a high risk of ischemic complications. Therefore, the patient was consented for a superficial temporal artery (STA)-SCA bypass through subtemporal approach followed by direct clipping/ trapping of the aneurysm. Postoperative CTA showed occlusion of the aneurysm and patency of the parent vessels. Postoperatively, the patient experienced immediate transient left mild monoparesis and right IV nerve palsy, which recovered completely at 6-months follow-up. Results: Surgical treatment of SCA aneurysms is decreasing due to the existence of endovascular therapies such as stents and flow diverters. However, some cases may necessitate surgical treatment and revascularization procedures to maintain the blood flow of the parent artery and to treat the previous lesion. Conclusion: The STA-SCA bypass through the subtemporal approach is a feasible option to maintain the blood flow of the parent artery in cases of SCA requiring surgical treatment and trapping/direct clipping of the aneurysm.

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Embolization of a giant pediatric, posttraumatic, skull base internal carotid artery aneurysm with a liquid embolic agent

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.6.peds0953 ◽

2009 ◽

Vol 4 (5) ◽

pp. 449-452 ◽

Cited By ~ 10

Author(s):

Adam S. Reig ◽

Scott Simon ◽

Robert A. Mericle

Keyword(s):

Skull Base ◽

Internal Carotid ◽

Artery Aneurysm ◽

Embolic Agent ◽

Carotid Artery Aneurysm ◽

Internal Carotid Artery Aneurysm ◽

Embolic Agents ◽

Liquid Embolic ◽

Liquid Embolic Agent ◽

The Cost

Many treatments for posttraumatic, skull base aneurysms have been described. Eight months after an all-terrain-vehicle accident, this 12-year-old girl presented with right-side Horner syndrome caused by a 33 × 19–mm internal carotid artery aneurysm at the C-1 level. We chose to treat the aneurysm with a new liquid embolic agent for wide-necked, side-wall aneurysms (Onyx HD 500). We felt this treatment would result in less morbidity than surgery and was less likely to occlude the parent artery than placement of a covered stent, especially in a smaller artery in a pediatric patient. Liquid embolic agents also appear to be associated with a lower chance of recanalization and lower cost compared with stent-assisted coil embolization. After the patient was treated with loading doses of aspirin, clopidogrel bisulfate, and heparin, 99% of the aneurysm was embolized with 9 cc of the liquid embolic agent. There were no complications, and the patient remained neurologically stable. Follow-up angiography revealed durable aneurysm occlusion after 1 year. The cost of Onyx was less than the cost of coils required for coil embolization of similarly sized intracranial aneurysms at our institution. Liquid embolic agents can provide a safe, efficacious, and cost-effective approach to treatment of select giant, posttraumatic, skull base aneurysms in pediatric patients.

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