Preoperative Embolization of Venous Malformations Using n-Butyl Cyanoacrylate

2018 ◽  
Vol 52 (4) ◽  
pp. 269-274 ◽  
Author(s):  
Wibke Uller ◽  
Sherif El-sobky ◽  
Ahmad I. Alomari ◽  
Steven J. Fishman ◽  
Samantha A. Spencer ◽  
...  
Keyword(s):  
Blood Loss ◽  
Preoperative Embolization ◽  
Inpatient Stay ◽  
Venous Malformations ◽  
Iodized Oil ◽  
Safety And Efficacy ◽  
Median Volume ◽  
The Mean ◽  
Initial Results ◽  
Median Blood Loss

Purpose: The purpose of this study was to evaluate the safety and efficacy of preoperative percutaneous n-butyl cyanoacrylate (nBCA) embolization of venous malformations in children. Material and Methods: Clinical data were retrospectively reviewed in children who underwent embolization using nBCA followed by resection of venous malformations. Results: A total of 17 embolizations were performed in 14 patients (9 females, mean age: 5.5 years; median age: 3 years; range 0.1-16 years). The venous malformations involved the lower extremity and the knee joint (n = 7), the trunk (n = 4), head and neck (n = 2), and hand (n = 1). n-Butyl cyanoacrylate was diluted with iodized oil at a ratio of 1:3 to 1:5. The mean and median volume of nBCA per procedure were 2.1 and 2 mL, respectively (range: 0.5-8 mL). There were no complications associated with the procedures. The mean and median time between final embolization and resection were 3.6 and 2 days, respectively. All children underwent successful resection of the symptomatic lesions. The estimated mean and median blood loss were 75 and 50 mL, respectively (range: 5-350 mL). The postprocedure course was uneventful, the days to discharge ranged between 1 and 6 days (mean 3 days). Conclusion: Initial results suggest that preoperative percutaneous n-butyl cyanoacrylate embolization of venous malformations is safe and effective in children, with the potential for minimizing blood loss and inpatient stay.

Preoperative Embolization of Hypervascular Spinal Metastases Using Percutaneous Direct Injection with n-Butyl Cyanoacrylate

Neurosurgery ◽  
2006 ◽  
Vol 59 (2) ◽  
pp. E431-E432 ◽  
Author(s):  
Clemens M. Schirmer ◽  
Adel M. Malek ◽  
Eddie S. Kwan ◽  
Daniel A. Hoit ◽  
Simcha J. Weller
Keyword(s):  
Blood Loss ◽  
Surgical Resection ◽  
Direct Injection ◽  
Transarterial Embolization ◽  
Spinal Instrumentation ◽  
Spinal Metastases ◽  
Preoperative Embolization ◽  
Iodized Oil ◽  
Operative Blood Loss ◽  
Perioperative Morbidity

Abstract OBJECTIVE: Intraoperative blood loss constitutes a major cause of perioperative morbidity in surgical decompression and reconstruction of highly vascular spinal metastatic tumors. We propose a technique for embolization of highly vascular vertebral metastases using percutaneous direct injection using n-butyl cyanoacrylate (NBCA) instead of polymethylmethacrylate to complement preoperative transarterial embolization and to minimize operative blood loss. METHODS: Five patients with renal cell carcinoma metastases to the spine (one cervical, one thoracic, and three lumbar) underwent embolization by percutaneous direct injection of the affected vertebrae with a mixture of NBCA and iodized oil to supplement transarterial embolization with polyvinyl alcohol particles and fibered platinum coils. This was achieved via a transpedicular approach in four cases and by direct vertebral body puncture in one case. RESULTS: The percutaneous NBCA direct injection procedure was technically successful in all cases and was not associated with neurological or medical complications. All patients underwent subsequent vertebrectomy and spinal instrumentation. Surgical resection was performed with lower than expected blood loss and with a subjective improvement in tumor tissue handling and dissection. CONCLUSION: The extent of tumor devascularization can be improved by supplementing transarterial embolization with NBCA direct injection to decrease operative blood loss and increase the safety of surgical resection and stabilization of highly vascular spinal metastases.

scholarly journals Robotic Intracorporeal Ileal Conduit Formation: Initial Experience from a Single UK Centre

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Conrad V. Bishop ◽  
Nikhil Vasdev ◽  
Gregory Boustead ◽  
James M. Adshead
Keyword(s):  
Blood Loss ◽  
Ileal Conduit ◽  
Operating Time ◽  
Early Discharge ◽  
Outcome Data ◽  
Initial Experience ◽  
Median Length ◽  
Robotic Assisted ◽  
Initial Results ◽  
Median Blood Loss

Objectives. To describe our technique of robotic intracorporeal ileal conduit formation (RICIC) during robotic-assisted radical cystectomy (RARC). To report our initial results of this new procedure.Patients and Methods. Seven male and one female patients underwent RARC with RICIC over a six-month period. Demographic, operative, and outcome data was collected prospectively. Median patient age was 75 years (range 62–78 years). Median followup was 9 months (range 7–14 months).Results. RARC with RICIC was performed successfully in all eight patients. The median total operating time was 360 minutes (range 310–440 minutes) with a median blood loss of 225 mL (range 50–1000 mL). The median length of stay was nine days (range 6–34 days). Four patients (50%) were discharged within seven days. Four patients (50%) experienced one or more complications. This included two Clavien I complications, two Clavien II complications, and two Clavien III complications. Two patients (25%) required transfusion of two units each. To date, there have been no complications associated with the ileal conduit.Conclusion. Whilst being technically challenging, this procedure is safe, feasible, and reproducible. Patients who avoid complication show potential for rapid recovery and early discharge.

Low Morbidity Associated With the Use of Nbca Liquid Adhesive for Preoperative Transarterial Embolization of Central Nervous System Tumors

Neurosurgery ◽  
2006 ◽  
Vol 59 (1) ◽  
pp. 98-104 ◽  
Author(s):  
Louis J. Kim ◽  
Felipe C. Albuquerque ◽  
Ali Aziz-Sultan ◽  
Robert F. Spetzler ◽  
Cameron G. McDougall
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Blood Loss ◽  
Transarterial Embolization ◽  
Cns Tumors ◽  
Neurological Deficits ◽  
Preoperative Embolization ◽  
Tumor Type ◽  
Safety And Efficacy ◽  
Estimated Blood Loss

Abstract OBJECTIVE To determine the safety and efficacy of preoperative embolization of central nervous system (CNS) tumors with n-butyl cyanoacrylate (NBCA) liquid adhesive. METHODS Over a 6-yr period, 35 consecutive patients (12 women, 23 men; mean age, 42 yr; range, 6 mo to 75 yr) with a CNS tumor underwent preoperative embolization with NBCA. Tumor type, location, endovascular and surgical treatment, percent of tumor embolization, estimated blood loss, and neurological deficits related to embolization were evaluated retrospectively. RESULTS One hundred feeding arteries were embolized (mean, 3 vessels/patient). In only one case (3%) a normal artery was inadvertently occluded by the embolization. During follow-up the resulting neurological deficit resolved completely. There were no neurological deficits or inadvertent embolization events in the remaining 34 cases. The mean percent of tumor embolized was 68%, but did not significantly correlate with operative blood loss (Pearson's correlation coefficient, r = 0.049). CONCLUSION In experienced hands, CNS tumors can be embolized with NBCA liquid adhesive with a high degree of safety and efficacy. We believe that adroit embolization technique with NBCA and other embolisates should be part of the contemporary neuroendovascular armamentarium.

Safety and Efficacy of Preoperative Embolization of Intracranial Hemangioblastomas

2015 ◽  
Vol 12 (2) ◽  
pp. 135-140 ◽  
Author(s):  
Chibawanye I Ene ◽  
David Xu ◽  
Ryan P Morton ◽  
Samuel Emerson ◽  
Michael R Levitt ◽  
...  
Keyword(s):  
Blood Loss ◽  
Surgical Resection ◽  
Gross Total Resection ◽  
Embolic Agent ◽  
Vascular Tumors ◽  
Preoperative Embolization ◽  
Intraoperative Blood Loss ◽  
Total Resection ◽  
Safety And Efficacy ◽  
Embolic Agents

Abstract BACKGROUND Intracranial hemangioblastomas are highly vascular tumors that account for 1% to 2% of all central nervous system tumors. Preoperative embolization has been proposed to limit the often significant intraoperative blood loss associated with resection and potentially make the tumor more soft/necrotic and thus more amenable to gross total resection. The safety and efficacy of preoperative embolization of intracranial hemangioblastomas, however, are not well characterized. OBJECTIVE To evaluate the safety and efficacy of preoperative endovascular embolization of intracranial hemangioblastomas using a variety of embolic agents. METHODS A retrospective review of all surgically resected intracranial hemangioblastomas treated with preoperative embolization between 1999 and 2014 at 2 high-volume centers was performed. Clinical and radiographic criteria, including von Hippel-Lindau status, magnetic resonance imaging tumor characteristics, embolization-related complications, degree of angiographic devascularization, intraoperative blood loss, ability to obtain gross total resection, transfusion requirements, and operative time, were analyzed. RESULTS A total of 54 patients underwent surgery, with 24 undergoing preoperative embolization followed by surgical resection, and 30 patients undergoing surgical resection alone. Embolization-related neurological complications were seen in 6 patients (25%), including 3 hemorrhages when polyvinyl alcohol particles (P = .04) were used and 3 infarctions when liquid embolic agents were used (P = .27). Permanent neurological deficits were seen in 15%. CONCLUSION Preoperative embolization of intracranial hemangioblastomas should be performed with caution, given the potential for neurological morbidity. Further studies are needed to help guide patient and embolic agent selection.

Safety and efficacy of vascular tumor embolization using Onyx: is angiographic devascularization sufficient?

2010 ◽  
Vol 112 (5) ◽  
pp. 1039-1045 ◽  
Author(s):  
Mohamed Samy Elhammady ◽  
Stacey Quintero Wolfe ◽  
Ramsey Ashour ◽  
Hamad Farhat ◽  
Roham Moftakhar ◽  
...  
Keyword(s):  
Blood Loss ◽  
Vascular Tumor ◽  
Spinal Tumors ◽  
Vascular Tumors ◽  
Embolic Material ◽  
Safety And Efficacy ◽  
Tumor Embolization ◽  
The Mean ◽  
Tumor Bleeding ◽  
Head Neck

Object The authors assessed the safety and efficacy of embolization of head, neck, and spinal tumors with Onyx and determined the correlation between tumor embolization and intraoperative blood loss. Methods The authors prospectively collected all head, neck, and spinal tumors embolized with Onyx at their institution over a 28-month period. Information on tumor type, location, extent of tumor devascularization, endovascular and surgical complications, and intraoperative estimated blood loss (EBL) was evaluated. Results Forty-three patients with various head, neck, and spinal lesions underwent vascular tumor embolization with Onyx. Indications for embolization included uncontrolled tumor bleeding in 8 cases, elective preoperative devascularization in 34, and tumor-induced consumptive thrombocytopenia in 1 case. Embolization was performed via direct tumoral puncture in 14 cases and through the traditional transarterial route in the remaining lesions. Embolization was successful in ending uncontrolled tumor bleeding in all 8 cases and in reversing the consumptive coagulopathy in 1 case. Intraparenchymal penetration of embolic material was possible in all percutaneously embolized tumors and in 4 of the 20 tumors embolized preoperatively via the transarterial route. The mean percentage of devascularization in tumors with intraparenchymal penetration of Onyx was 90.3% compared with 83.7% in tumors without intraparenchymal penetration. The mean EBL with intraparenchymal penetration of Onyx was significantly lower than when there was no intraparenchymal penetration (459 vs 2698 ml; p = 0.0067). There were no neurological complications related to the embolization procedures. Conclusions Embolization of vascular tumors with Onyx can be performed safely but may not reach optimal effectiveness in reducing intraoperative EBL if the embolic material does not penetrate the tumor vasculature. In the authors' experience, the best method of intraparenchymal penetration is achieved with direct tumor puncture. Transarterial embolization may not result in tumor penetration, particularly when injected from a long distance through small caliber or slow flow vessels.

Is There a Benefit of Preoperative Meningioma Embolization?

Neurosurgery ◽  
2000 ◽  
Vol 47 (6) ◽  
pp. 1306-1312 ◽  
Author(s):  
Martin Bendszus ◽  
Gerad Rao ◽  
Ralf Burger ◽  
Carlo Schaller ◽  
Katrin Scheinemann ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Blood Loss ◽  
Neurological Status ◽  
Entire Group ◽  
Preoperative Embolization ◽  
Resonance Imaging ◽  
Surgical Morbidity ◽  
The Mean ◽  
Tumor Consistency

ABSTRACT OBJECTIVE To evaluate the effect of preoperative embolization of meningiomas on surgery and outcomes. METHODS In a prospective study, 60 consecutive patients with intracranial meningiomas who were treated in two neurosurgical centers were included. In Center A, embolization was performed for none of the patients (n = 30). In Center B, 30 consecutive patients with embolized meningiomas were treated. Preoperatively, tumor size and location, neurological status, and Barthel scale score were recorded. In Center B, the extent of tumor devascularization was evaluated using angiography and postembolization magnetic resonance imaging. Intraoperatively, blood loss, the numbers of blood units transfused, and the observations of the neurosurgeon concerning hemostasis, tumor consistency, and intratumoral necrosis were recorded. Postoperatively, the neurological status and duration of hospitalization were recorded. Six months after surgery, the outcomes were assessed using the Barthel scale and neurological examinations. RESULTS The mean tumor sizes were 22.9 cc in Center A and 29.6 cc in Center B (P > 0.1). The mean blood losses did not differ significantly (646 ml in Center A versus 636 ml in Center B;P > 0.5). However, for a subgroup of patients with subtotal devascularization (>90% of the tumor) on postembolization magnetic resonance imaging scans in Center B, blood loss was less, compared with the entire group in Center A (P < 0.05). The observations of the neurosurgeon regarding hemostasis, tumor consistency, and intratumoral necrosis did not differ significantly. There were no surgery-related deaths in either center. The rates of surgical morbidity, with permanent neurological worsening, were 20% (n = 6) in Center A and 16% (n = 5) in Center B. There was one permanent neurological deficit (3%) caused by embolization. CONCLUSION In this preliminary study, only complete embolization had an effect on blood loss. The value of preoperative embolization for all meningiomas must be reconsidered, especially in view of the high costs and risks of embolization.

scholarly journals Initial experience with dual-lumen balloon catheter injection for preoperative Onyx embolization of skull base paragangliomas

2016 ◽  
Vol 124 (6) ◽  
pp. 1813-1819 ◽  
Author(s):  
Travis R. Ladner ◽  
Lucy He ◽  
Brandon J. Davis ◽  
George L. Yang ◽  
George B. Wanna ◽  
...  
Keyword(s):  
Blood Loss ◽  
Balloon Catheter ◽  
The Other ◽  
Preoperative Embolization ◽  
Initial Experience ◽  
Selective Embolization ◽  
Tumor Penetration ◽  
Estimated Blood Loss ◽  
The Mean ◽  
Clinical Records

OBJECT Paragangliomas are highly vascular head and neck tumors for which preoperative embolization is often considered to facilitate resection. The authors evaluated their initial experience using a dual-lumen balloon to facilitate preoperative embolization in 5 consecutive patients who underwent preoperative transarterial Onyx embolization assisted by the Scepter dual-lumen balloon catheter between 2012 and 2014. OBJECT The authors reviewed the demographic and clinical records of 5 patients who underwent Scepter-assisted Onyx embolization of a paraganglioma followed by resection between 2012 and 2014. Descriptive statistics of clinical outcomes were assessed. RESULTS Five patients (4 with a jugular and 1 with a vagal paraganglioma) were identified. Three paragangliomas were embolized in a single session, and each of the other 2 were completed in 3 staged sessions. The mean volume of Onyx used was 14.3 ml (range 6–30 ml). Twenty-seven vessels were selectively catheterized for embolization. All patients required selective embolization via multiple vessels. Two patients required sacrifice of parent vessels (1 petrocavernous internal carotid artery and 1 vertebral artery) after successful balloon test occlusion. One patient underwent embolization with Onyx-18 alone, 2 with Onyx-34 alone, and 1 with Onyx-18 and −34. In each case, migration of Onyx was achieved within the tumor parenchyma. The mean time between embolization and resection was 3.8 days (range 1–8 days). Gross-total resection was achieved in 3 (60%) patients, and the other 2 patients had minimal residual tumor. The mean estimated blood loss during the resections was 556 ml (range 200–850 ml). The mean postoperative hematocrit level change was −17.3%. Two patients required blood transfusions. One patient, who underwent extensive tumor penetration with Onyx, developed a temporary partial cranial nerve VII palsy that resolved to House-Brackmann Grade I (out of VI) at the 6-month follow-up. One patient experienced improvement in existing facial nerve weakness after embolization. CONCLUSIONS Scepter catheter-based Onyx embolization seems to be safe and effective. It was associated with excellent distal tumor vasculature penetration and holds promise as an adjunct to conventional transarterial Onyx embolization of paragangliomas. However, the ease of tumor penetration should encourage caution in practitioners who may be able to effect comparable improvement in blood loss with more conservative proximal Onyx penetration.

scholarly journals Expanded endoscopic endonasal surgery for advanced stage juvenile angiofibromas: a retrospective multi-center study

2016 ◽  
Vol 54 (3) ◽  
pp. 239-246
Author(s):  
C. Langdon ◽  
P. Herman ◽  
B. Verillaud ◽  
R.L. Carrau ◽  
D. Prevedello ◽  
...  
Keyword(s):  
Blood Loss ◽  
Multicenter Study ◽  
Residual Disease ◽  
Long Term Results ◽  
Intracranial Extension ◽  
Preoperative Embolization ◽  
Advanced Stage ◽  
The Mean ◽  
Retrospective Multicenter Study

Objectives: Endoscopic resection has become an established surgical option for most juvenile nasopharyngeal angiofibromas (JNA). However, surgical management of JNA with intracranial extension remains challenging. This retrospective multicenter study reviews a series of patients with advanced stage JNA treated via endonasal/endoscopic approach. Methods: The experience of five academic tertiary or quaternary care ORL-HNS Departments were included. Medical records of all patients operated for JNA staged as Radkowski stage IIIA or IIIB were reviewed. Main outcome measures included intraoperative blood loss, length of hospital stay, complication rate, and rate of persistence or recurrence. Results: A total of 74 male patients with stages IIIA and IIIB were included. The mean age was 16.4 years and preoperative embolization was performed in 71 patients. The mean blood loss in 45 patients for whom the data was available was 1279.7 ml. The more anatomic subsites were involved, the higher the risk was of intraoperative bleeding. The mean follow-up for 54 out of 73 patients was 37.9 months. Patients with residual disease are significantly linked to involvement of combined (anterior-lateral and posterior) anatomic subsites and to a higher number of affected subsites. At last follow-up, all patients were asymptomatic and those with residual tissue displayed no imaging signs of growth. Conclusions: This retrospective multicenter study supports the notion that expanded endonasal endoscopic approaches for advance staged JNA are a feasible option associated with good long-term results.

Results of preoperative embolization for metastatic spinal neoplasms

2003 ◽  
Vol 98 (2) ◽  
pp. 156-164 ◽  
Author(s):  
Vikram C. Prabhu ◽  
Mark H. Bilsky ◽  
Kedar Jambhekar ◽  
Katherine S. Panageas ◽  
Patrick J. Boland ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Blood Loss ◽  
Predictive Value ◽  
Preoperative Embolization ◽  
Intraoperative Blood Loss ◽  
Spinal Neoplasms ◽  
Tumor Vascularity ◽  
Content Type ◽  
The Mean ◽  
Fine Print

Object. Arterial embolization reduces blood loss in patients undergoing surgery for hypervascular spinal tumors. The objectives of this study were twofold: 1) to evaluate the role of magnetic resonance (MR) imaging in predicting tumor vascularity and 2) to assess the effectiveness of preoperative embolization in devascularizing these tumors. Methods. Fifty-one patients with metastatic spinal neoplasms underwent angiography, preoperative embolization, and excision of the lesion between 1995 and 2000. The MR imaging studies were correlated with tumor vascularity on angiograms. Embolization was angiographically graded on a five-point scale ranging from no embolization (Grade A) to total embolization (Grade E). The embolization grade was correlated with intraoperative blood loss. The mean age was 57 years, the male/female ratio was 1.2:1, and back pain was present in all patients. Metastatic renal cell carcinoma (30 cases) and thoracic spine involvement (33 cases) were most frequent. The positive predictive value of MR imaging in determining tumor vascularity was 77%, whereas the negative predictive value was 21%. Total embolization (Grade E) was achieved in 34 patients. A shared vascular pedicle between a radiculomedullary artery (RMA) and a tumor diminished the likelihood of complete embolization (p = 0.02). Small asymptomatic cerebellar infarctions were demonstrated in two cases. The mean intraoperative blood loss was 2586 ml. Following Grade D or E embolization, intraoperative bleeding was largely related to unembolized epidural veins. Conclusions. Tumor histology and MR imaging findings are predictive of hypervascularity; however, hypervascular tumors may not be detected by standard MR imaging sequences. Superselective catheterization permits Grade D or E embolization in 80% of patients. Shared blood supply with an RMA is the most important factor precluding complete embolization.

scholarly journals The safety and efficacy of preoperative embolization of meningioma with N-butyl cyanoacrylate

2015 ◽  
Vol 21 (5) ◽  
pp. 624-630 ◽  
Author(s):  
Hideaki Ishihara ◽  
Shoichiro Ishihara ◽  
Jun Niimi ◽  
Hiroaki Neki ◽  
Yoshiaki Kakehi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Blood Loss ◽  
Tumor Volume ◽  
Volume Ratio ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Intraoperative Blood Loss ◽  
Safety And Efficacy ◽  
Injection Speed ◽  
Intratumoral Bleeding

Objective Preoperative embolization of meningioma is commonly performed; however, there is no consensus on the best embolic material to reduce intraoperative blood loss and surgery time. Method We retrospectively assessed the safety and efficacy of 56 cases of preoperative embolization of the middle meningeal artery with N-butyl cyanoacrylate (NBCA) in 105 cases of surgery for meningioma. We also defined a blood loss to tumor volume ratio to compensate for bias caused by tumor volume, and analyzed limited cases (the embolized group n = 52, the non-embolized group n = 21) of the convexity, the parasagittal region, the falx, and the sphenoidal ridge. Result The blood loss to tumor volume ratio was significantly less in the embolized group ( p < 0.007). Preoperative embolization could be useful for cases with the external carotid artery as the dominant feeder vessel ( p < 0.02); however, the efficacy decreased for cases with an internal carotid artery feeder. Transient complications occurred in four cases (hemiparesis secondary to edema: two cases; intratumoral bleeding: one case; trigeminal nerve disorder: one case). The cases that showed a postoperative increase in edema or intratumoral bleeding were large tumors with the early filling of veins. For such cases, surgeons should pay close attention to slow injection speed and higher NBCA viscosity, not to cause the occlusion of draining vessels. Conclusion Tumor embolization with NBCA can be safely performed, and the procedure significantly reduces intraoperative blood loss.

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