Use of Intraoperative Indocyanine Green Angiography for Feeder Vessel Ligation and En Bloc Resection of Intramedullary Hemangioblastoma

2019 ◽  
Vol 17 (6) ◽  
pp. 573-579 ◽  
Author(s):  
Camilo A Molina ◽  
Zach Pennington ◽  
A Karim Ahmed ◽  
Erick Westbroek ◽  
Matthew L Goodwin ◽  
...  
Keyword(s):  
Blood Loss ◽  
Indocyanine Green ◽  
Fluorescent Dyes ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Vascular Tumors ◽  
Intraoperative Blood Loss ◽  
En Bloc ◽  
Feeder Vessel ◽  
Decrease Blood Loss

Abstract BACKGROUND As vascular tumors, intramedullary hemangioblastomas are associated with significant intraoperative blood loss, making them particularly challenging clinical entities. The use of intraoperative indocyanine green or other fluorescent dyes has previously been described to avoid breaching the tumor capsule, but improved surgical outcomes may result from identifying and ligating the feeder arteries and arterialized draining veins. OBJECTIVE To describe the use of combined preoperative angiography and intraoperative indocyanine green use for the identification of feeder arteries and arterialized draining veins to decrease blood loss in the resection of intramedullary hemangioblastomas. METHODS A patient with cervical myelopathy secondary to a large C3 hemangioblastoma and cervicothoracic syrinx underwent a C2-3 laminoplasty with resection of the lesion. To reduce intraoperative blood loss and facilitate safe lesion resection, the vascular architecture of the lesion was defined via preoperative digital subtraction angiography and intraoperative use of indocyanine green. The latter permitted ligation of the major and minor feeding arteries and arterialized veins prior to tumor breach, allowing for facile en bloc resection of the lesion. RESULTS The lesion was resected en bloc with minimal blood loss (approximately 100 mL) and without intraoperative neuromonitoring signal changes. The patient remained at neurological baseline throughout their stay. CONCLUSION We present a written and media illustration of a technique for intraoperative indocyanine green use in the en bloc resection of intramedullary hemangioblastoma.

scholarly journals Transarterial Embolization Treatment of Sacral Tumors

2018 ◽  
Vol 1 (Supplement) ◽  
pp. 35
Author(s):  
D. Anghelescu ◽  
E. Popescu ◽  
A. Cursaru ◽  
A. Dimitriu ◽  
R. Ene ◽  
...  
Keyword(s):  
Blood Loss ◽  
Late Onset ◽  
Transarterial Embolization ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Recurrence Rates ◽  
En Bloc ◽  
Complete Excision ◽  
Perioperative Blood Loss ◽  
Sacral Tumors

Abstract Objectives. Sacral tumors represent about 1-4,3% of all bone tumors. They typically present with an abundance of blood vessels. Due to their anatomical localization, they are hard to approach surgically. Thus, a presurgical neoadjuvant therapy is indicated. The preoperative angiography with the embolization of the nutritive arteries decreases the perioperative blood loss and the symptomatology, and even decreases the volume of the tumors that cannot be surgically approached. Materials and methods. The principle of embolization consists in the targeting of the nutritive tumoral artery and in obturating it with embolic agents (polyvinyl alcohol, embospheres, etc.) through selective catheterization under angiographic control. The biopsy of the tumor is essential for certain diagnosis. The histological type of the tumor and the degree of differentiation influence the tumor’s physiopathology and often influence the therapeutic decision regarding its degree or recurrence. In some cases in which the tumor’s degree of extension increases the surgical risk, serial embolization can be used as a primary method of treatment. Because of the late onset symptomatology, when they are discovered they are extended and the degree of invasion in adjacent tissues is so high that it requires en bloc resection with nerve root sacrifice to assert complete excision and low recurrence rates. Results. The patients who undergo surgical treatment usually bleed, and the perioperative blood loss and the need for blood transfusion volumes were halved in the cases in which presurgical transarterial embolization was performed. Conclusions. Transarterial embolization of sacral tumors is a procedure indicated as a neoadjuvant presurgical therapy to decrease the blood loss risks and for the tumors that cannot be surgically removed it is used in the palliative treatment to reduce symptomatology.

Surgical Resection of Calvarial Metastases Overlying Dural Sinuses

Neurosurgery ◽  
2001 ◽  
Vol 48 (4) ◽  
pp. 745-755 ◽  
Author(s):  
Christopher B. Michael ◽  
Ziya L. Gokaslan ◽  
Franco DeMonte ◽  
Ian E. McCutcheon ◽  
Raymond Sawaya ◽  
...  
Keyword(s):  
Blood Loss ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Venous Sinus ◽  
Neurological Deficits ◽  
Dural Sinus ◽  
En Bloc ◽  
Primary Tumors ◽  
Venous Sinuses ◽  
Piecemeal Resection

Abstract OBJECTIVE Few reports have addressed the surgical management of cranial metastases that overlie or invade the dural venous sinuses. To examine the role of surgery in the treatment of dural sinus calvarial metastases, we reviewed retrospectively 13 patients who were treated with surgery at the University of Texas M.D. Anderson Cancer Center between 1993 and 1999. We compared them with 14 patients who had calvarial metastases that did not involve a venous sinus. METHODS Clinical charts, radiological studies, pathological findings, and operative reports were analyzed retrospectively. RESULTS The median age of patients with dural sinus calvarial metastases was 54 years. Nine patients were men and four were women. Renal cell carcinoma and sarcoma were the most common primary tumors. Similar features were noted in the 14 patients with nonsinus calvarial metastases. Of the 13 dural sinus calvarial metastases, 11 involved the superior sagittal sinus, and 2 involved the transverse sinus. In nine patients, the involved sinus was resected, and in four patients, the sinus was reconstituted after tumor removal. Nine patients in the dural sinus calvarial metastases group received en bloc resection, and four received piecemeal resection. No operative deaths occurred. The overall median actuarial survival was 16.5 months. The survival times of the two groups were comparable. In the group with dural sinus calvarial metastases, transient postoperative neurological deficits occurred in two patients (15%), and a permanent deficit occurred in one patient (8%). No patients in the group with nonsinus calvarial metastases experienced deficits after resection. Compared with piecemeal resection, en bloc resection was associated with significantly less blood loss. CONCLUSION Complete extirpation of calvarial metastases that overlie or invade a dural sinus can be achieved with only slightly more morbidity than complete removal of calvarial metastases that are located away from the sinuses. En bloc resection is as safe as piecemeal resection and is more effective in limiting operative blood loss. The overall recurrence and survival rates of patients with dural sinus calvarial metastases are similar to those of patients with calvarial metastases that do not involve the sinuses. Therefore, involvement of a dural venous sinus should not discourage resection of calvarial metastases. In carefully selected cancer patients, surgery provides effective palliation of symptomatic calvarial metastases that overlie or invade the venous sinuses.

scholarly journals Preoperative Transcatheter Arterial Embolization and En-Bloc Resection for Giant Non-Functioning Left Adrenocortical Carcinoma: A Case Report

2021 ◽  
pp. 1-5
Author(s):  
Giorgio Lucandri ◽  
Giorgio Lucandri ◽  
Giuseppe Mezzetti ◽  
Marco Maria Lirici ◽  
Alessia Fassari ◽  
...  
Keyword(s):  
Case Report ◽  
Blood Loss ◽  
Adjuvant Treatment ◽  
Transcatheter Arterial Embolization ◽  
Adrenocortical Carcinoma ◽  
Locally Advanced ◽  
Arterial Embolization ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc

Objective: To demonstrate efficacy and relative safety of compartment surgery in a case of large sized adrenocortical carcinoma (ACC), whenever associated with preoperative transcatheter arterial embolization (TAE) and adjuvant treatment with mitotane. Introduction: ACC is a rare illness; non-functioning lesions account for 40-55% of patients, may reach a large size, and show a clear attitude to infiltrate neighbouring organs. Case Report: Middle aged male visited for a huge left abdominal mass; contrast CT scan showed origin from the left adrenal lodge and possible extension of the tumor to surrounding structures. Preoperative adrenal work-up confirmed non-functioning nature of the adrenal mass. In order to allow a safe compartment excision and to decrease blood loss, preoperative angiography and TAE was performed. Patient underwent en-bloc resection of the mass, together with nephrectomy and distal splenopancreasectomy. No postoperative transfusions were required. Patient received adjuvant therapy with mitotane for 36 months since surgery, without any sign of tumor recurrence. Conclusion: An aggressive surgical approach seems justified also in locally advanced and infiltrating ACC; compartment resection is mandatory in order to obtain adequate resection margins. Preoperative TAE decreases intraoperative blood loss and need for transfusions. Adjuvant treatment with mitotane may contribute to reach remarkable disease-free survival.

scholarly journals Underwater endoscopic mucosal resection for en bloc resection of a neuroendocrine tumor in the duodenal bulb

Endoscopy ◽  
2021 ◽  
Author(s):  
Hugo Uchima ◽  
Alberto Diez-Caballero ◽  
Jaume Capdevila ◽  
Mercé Rosinach ◽  
Alfredo Mata ◽  
...  
Keyword(s):  
Neuroendocrine Tumor ◽  
Endoscopic Mucosal Resection ◽  
Duodenal Bulb ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Mucosal Resection

scholarly journals Fibrin glue: Novel submucosal injection agent for endoscopic submucosal dissection

2021 ◽  
Vol 09 (03) ◽  
pp. E319-E323
Author(s):  
Madoka Takao ◽  
Yoshitaka Takegawa ◽  
Toshitatsu Takao ◽  
Hiroya Sakaguchi ◽  
Yoshiko Nakano ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Fibrin Glue ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Submucosal Injection ◽  
Submucosal Dissection ◽  
Vitro Model ◽  
Histopathologic Findings

Abstract Background and study aims Adequate mucosal elevation by submucosal injection is crucial for patient safety and efficiency during endoscopic submucosal dissection (ESD). This study aimed to evaluate the efficacy of fibrin glue (FG) as a long-lasting submucosal injection agent and to evaluate the technical feasibility of FG injection for ESD. Materials and methods To compare the capabilities of different agents in maintaining submucosal evaluation, we injected FG, hyaluronic acid solution, and normal saline into the porcine gastric specimen that was incised into approximately 5 × 5 cm squares. Then, we measured the height of submucosal elevations over time. Moreover, three hypothetical lesions from the resected porcine stomach underwent ESD with FG injection. Thereafter, we conducted macroscopic and histopathologic analyses. Results FG maintained the greatest submucosal elevation among all the injection agents. Three ESD procedures were performed with en bloc resection. Both macroscopic and histopathologic findings showed a thick FG clot on the ulcers. Conclusions The FG solution can be potentially used as an ESD submucosal injection agent in an in vitro model.

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