Preoperative transarterial embolization of a recurrent orbital solitary fibrous tumor with significant hypervascularity: a case report

Abstract Background Orbital solitary fibrous tumors (SFTs) are rare neoplasms. Recurrent, hypervascular, malignant variations of orbital SFTs have recently been noted and can present a surgical challenge. Case presentation We describe a case of a 53-year-old Chinese woman with a history of a resected orbital SFT. She presented with proptosis, limited eyeball movement, and visual loss in the right eye, suggestive of a recurrent SFT. Ocular examination with multimodal imaging revealed a large, nonpulsatile, noncompressible, hypervascular mass behind the eyeball. The patient underwent preoperative transarterial embolization of the main blood supply to the tumor in order to control intraoperative blood loss, followed by ocular enucleation to optimize exposure and enable complete resection of the tumor. Embolization of the right ophthalmic artery and the distal branch of the right internal maxillary artery caused an immediate, substantial reduction of vascular flow, which allowed us to enucleate the eyeball and resect the tumor with minimal blood loss and no complications. Conclusions Our case is so far the first Chinese case of successful preoperative embolization of the main blood supply to a large, recurrent, hypervascular orbital SFT. This case also described a different surgical approach to achieve total removal of an orbital SFT without osteotomy.

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Preoperative Onyx embolization of a giant cavernous malformation involving the dural sinuses

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.1.peds08412 ◽

2009 ◽

Vol 3 (4) ◽

pp. 302-306 ◽

Cited By ~ 3

Author(s):

Shervin R. Dashti ◽

David Fiorella ◽

Robert F. Spetzler ◽

Elisa Beres ◽

Cameron G. McDougall ◽

...

Keyword(s):

Blood Loss ◽

Transarterial Embolization ◽

Vascular Lesions ◽

Preoperative Embolization ◽

Cavernous Malformations ◽

Dural Sinuses ◽

Ideal Agent ◽

Liquid Embolic ◽

Feeding Vessels ◽

The Right

Cavernous malformations (CMs) or hemangiomas arising from within the dural sinuses are rare entities that differ from their parenchymal counterparts in that they are highly vascular lesions. While parenchymal CMs are typically angiographically occult, intrasinus malformations may have large, dural-based arterial feeding vessels that are amenable to preoperative embolization. The novel liquid embolic Onyx (ev3, Inc.) is an ideal agent for the embolization of these lesions. The authors present the first known case of a giant intrasinus CM embolized with Onyx before gross-total resection. The authors report the case of a 9-year-old boy with brief apneic episodes in whom MR imaging revealed a giant CM arising from within the right transverse and sigmoid sinuses and infiltrating the right tentorium cerebelli. At another institution, the patient had undergone 1 prior embolization and 2 unsuccessful attempts at resection. Both surgeries had been complicated by massive blood loss and were aborted. Under the authors' care, the patient underwent preoperative transarterial embolization with Onyx during which a substantial volume of the mass lesion was filled with embolisate. Subsequently, complete circumferential excision of the mass from the tentorium was accomplished with minimal intraoperative blood loss.

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Transpedicular N-butyl cyanoacrylate–mediated percutaneous embolization of symptomatic vertebral hemangiomas

Journal of Neurosurgery Spine ◽

10.3171/2013.1.spine11173 ◽

2013 ◽

Vol 18 (5) ◽

pp. 450-455 ◽

Cited By ~ 8

Author(s):

Kevin C. Yao ◽

Adel M. Malek

Keyword(s):

Blood Loss ◽

Direct Injection ◽

Transarterial Embolization ◽

High Volume ◽

Vascular Tumors ◽

Intraoperative Blood Loss ◽

Percutaneous Embolization ◽

Direct Puncture ◽

Tumor Embolization ◽

Large Channel

Object The resection of spinal hemangiomas is often challenging because of characteristic high-volume and potentially prohibitive intraoperative blood loss. Although transarterial embolization can mitigate this risk, it can be suboptimal when tumor arterial supply is diffuse or poorly defined. The authors present their experience in the use of preoperative percutaneous direct injection of spinal hemangiomas with N-butyl cyanoacrylate (NBCA) as an effective preoperative adjunct that may reduce operative blood loss and facilitate resection of these vascular tumors. Methods Four patients with symptomatic spinal hemangiomas were treated using percutaneous transpedicular direct NBCA-Lipiodol injection; 2 patients had undergone prior spinal angiography, with suboptimal transarterial embolization in 1. Each patient underwent percutaneous bilateral transpedicular NBCA-assisted tumor embolization prior to resection. Retrospective analysis of operative times, blood loss, and clinical data is presented. Results There were no complications associated with the percutaneous NBCA embolization technique. The procedure was effective at facilitating tumor removal and minimizing intraoperative blood loss, especially at the vertebral body resection stage. Improved tumor filling was achieved as the filling characteristics of dilute NBCA-Lipiodol mixture within large-channel, high-flow hemangiomas were appreciated with experience. Conclusions Transpedicular NBCA direct-puncture embolization of spinal hemangiomas is an effective preoperative adjunct that facilitates resection of these highly vascular tumors. It is particularly useful when transarterial embolization is unsafe or suboptimal due to constraints imposed by the local angioarchitecture.

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

Neurosurgery ◽

10.1227/01.neu.0000223503.92392.ce ◽

2006 ◽

Vol 59 (2) ◽

pp. E431-E432 ◽

Cited By ~ 28

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.

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STMO-02 Efficacy of preoperative embolization for hemangioblastoma

Neuro-Oncology Advances ◽

10.1093/noajnl/vdaa143.040 ◽

2020 ◽

Vol 2 (Supplement_3) ◽

pp. ii9-ii10

Author(s):

Takeshi Hiu ◽

Kousuke Hirayama ◽

Shiro Baba ◽

Kenta Ujifuku ◽

Koichi Yoshida ◽

...

Keyword(s):

Blood Loss ◽

Cerebral Infarction ◽

Transarterial Embolization ◽

Posterior Inferior Cerebellar Artery ◽

Superior Cerebellar Artery ◽

Anterior Inferior Cerebellar Artery ◽

Preoperative Embolization ◽

Cerebellar Hemangioblastoma ◽

Cerebellar Artery ◽

Hemorrhagic Complications

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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Tentorial Dural Arteriovenous Fistula Presenting with Various Visual Symptoms Related to Anterior and Posterior Visual Pathway Dysfunction: Case Report

Neurosurgery ◽

10.1227/01.neu.0000068873.63576.5e ◽

2003 ◽

Vol 53 (1) ◽

pp. 222-227 ◽

Cited By ~ 25

Author(s):

Goetz Benndorf ◽

Stefanie Schmidt ◽

Wolf-Peter Sollmann ◽

Stefan-Nikolaus Kroppenstedt

Keyword(s):

Cavernous Sinus ◽

Transarterial Embolization ◽

Venous Drainage ◽

Visual Pathway ◽

Sudden Onset ◽

Left Vertebral Artery ◽

Visual Symptoms ◽

Meningeal Arteries ◽

History Of ◽

The Right

Abstract OBJECTIVE AND IMPORTANCE Dural arteriovenous fistulae (DAVFs) not directly shunting into the cavernous sinus are an infrequent cause of visual dysfunction. An unusual case of a tentorial DAVF associated with visual symptoms related to dysfunction of the anterior and posterior visual pathway is presented. CLINICAL PRESENTATION A 38-year-old woman with a history of long-standing bilateral proptosis experienced a sudden onset of headache and visual disturbances. Ocular examination revealed bilateral episcleral and retinal venous congestion, optic disc paleness, right superior homonymous quadrantanopsia in both eyes, and concentric narrowing of the visual field of the right eye. Angiography revealed a DAVF supplied by a falx branch arising from the left vertebral artery and both middle meningeal arteries, which drained directly into the markedly dilated vein of Galen via the basal vein of Rosenthal and the cavernous sinus into both superior ophthalmic veins. INTERVENTION Endovascular treatment was performed in two consecutive sessions by transarterial embolization with n-butylcyanoacrylate, which resulted in occlusion of the fistula and complete clinical cure, confirmed at the 6-month follow-up examination. CONCLUSION Various neuro-ophthalmological findings may be caused by an arteriovenous lesion remote from the optic organ as a result of rerouting of venous drainage compromising the visual pathway at different locations. Transarterial embolization of a DAVF may result in complete cure if advantageous arterial anatomy allows for flow control and occlusion of the fistulous connection with liquid adhesives.

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

Neurosurgery ◽

10.1227/01.neu.0000220215.71485.07 ◽

2006 ◽

Vol 59 (1) ◽

pp. 98-104 ◽

Cited By ~ 35

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.

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Transarterial embolization of an internal maxillary artery arteriovenous fistula presenting with pulsatile tinnitus

Neurosurgical FOCUS ◽

10.3171/2019.1.focusvid.18479 ◽

2019 ◽

Vol 46 (Suppl_1) ◽

pp. V7

Author(s):

Waleed Brinjikji ◽

Harry J. Cloft ◽

Giuseppe Lanzino ◽

Leonardo Rangel-Castilla ◽

Pearse P. Morris

Keyword(s):

Arteriovenous Fistula ◽

Transarterial Embolization ◽

Maxillary Artery ◽

Internal Maxillary Artery ◽

Pulsatile Tinnitus ◽

Endovascular Techniques ◽

Arteriovenous Fistulae ◽

Common Presentation ◽

Single Hole ◽

History Of

Arteriovenous fistulae of the internal maxillary artery are exceedingly rare, with less than 30 cases reported in the literature. Most of these lesions are congenital, iatrogenic, or posttraumatic. The most common presentation of internal maxillary artery fistulae is pulsatile tinnitus and headache. Because these lesions are single-hole fistulae, they can be easily cured with endovascular techniques. The authors present a case of a patient who presented to their institution with a several-year history of pulsatile tinnitus who was found to have an internal maxillary artery arteriovenous fistula, which was treated endovascularly with transarterial coil and Onyx embolization.The video can be found here: https://youtu.be/fDZVMMwpwRc.

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Arteriovenous malformation presenting as traumatic subdural hematoma: A case report

Surgical Neurology International ◽

10.25259/sni_160_2019 ◽

2020 ◽

Vol 11 ◽

pp. 203

Author(s):

Matthew Parr ◽

Nitesh Patel ◽

John Kauffmann ◽

Fawaz Al-Mufti ◽

Sudipta Roychowdhury ◽

...

Keyword(s):

Subdural Hematoma ◽

Emergency Services ◽

Vascular Lesion ◽

Initial Presentation ◽

Vascular Lesions ◽

Hematoma Expansion ◽

Preoperative Embolization ◽

History Of ◽

The Right ◽

High Index Of Suspicion

Background: Brain arteriovenous malformations (AVMs) are congenital aberrant connections between afferent arteries and draining veins with no intervening capillary bed or neural parenchyma. Other than seizures, the most common initial presentation of AVM is hemorrhage, which is typically intraparenchymal, subarachnoid, or intraventricular, and very rarely subdural. Case Description: This patient is a 66-year-old male with a history of atrial fibrillation, chronically anticoagulated with apixaban, who presented through emergency services after a fall. On presentation, computed tomography (CT) of the head showed a small, 6 mm right subdural hematoma, and the patient was neurologically intact. The hematoma was evacuated by burr hole craniotomy and placement of a subdural drain 12 days after the initial presentation due to worsening headaches and further hematoma expansion. Two weeks postevacuation, the patient was readmitted for seizures, and at this time, CT angiography showed no intracranial vascular lesion. Approximately 1 month later, the patient was readmitted for decreased responsiveness, and CT head at this time found right frontal intraparenchymal hemorrhage. On subsequent catheter angiography, the right frontal AVM was discovered. It was treated with preoperative embolization followed by surgical resection. Postoperatively, the patient followed commands and tracked with his eyes. There was spontaneous antigravity movement of the right upper extremity, but still no movement of the left upper or bilateral lower extremities. Conclusion: This case emphasizes the importance of maintaining a high index of suspicion for underlying vascular lesions when evaluating intracranial bleeding, even in the setting of traumatic history, particularly in cases of hematoma expansion.

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Solitary Fibrous Tumor of Nasal Cavity in Patient With Long-Standing History of Cocaine Inhalation

Archives of Pathology & Laboratory Medicine ◽

10.5858/2004-128-e1-sftonc ◽

2004 ◽

Vol 128 (1) ◽

pp. e1-e4 ◽

Cited By ~ 2

Author(s):

Suman S. Chauhan ◽

Jayshree Krishnan ◽

Denis K. Heffner

Keyword(s):

Nasal Cavity ◽

Solitary Fibrous Tumor ◽

Soft Tissues ◽

S100 Protein ◽

Large Mass ◽

Left Nasal Cavity ◽

Posterior Aspect ◽

History Of ◽

Fibrous Tumor ◽

The Right

Abstract We report a solitary fibrous tumor in the nasal cavity of a 48-year-old woman who presented with a history of bilateral nasal obstruction and long-standing cocaine inhalation. Physical examination revealed a large mass involving the right nasal cavity and extending into the posterior aspect of the left nasal cavity. The computed tomography scan showed opacification of airways. During surgery, the mass was found to involve the entire nasal cavity, with extension to the right maxillary sinus, posterior nasal airways, and left nasal cavity. The mass was completely excised. Pathologic examination revealed a polypoid mass 3.7 × 3.0 × 1.2 cm. This tumor was composed of spindle cells that were cytologically bland in a background of ropey and nodular collagen, giving a “patternless” pattern. Immunohistochemically, the neoplastic cells stained for CD34 and vimentin but not for S100 protein, keratin, desmin, HMB-45, and c-Kit. This immunohistochemical pattern confirmed the diagnosis of solitary fibrous tumor. Although solitary fibrous tumors are usually found in the pleura, they can occur in various other locations, such as the orbit, nasal cavity, paranasal sinuses, mediastinum, breast, vagina, meninges, and soft tissues. This case is of interest because the tumor occurred in a patient with prolonged cocaine inhalation. Such an association has not been previously described. The exact causal relationship between cocaine inhalation and the tumor is not known.

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Perimedullary Arteriovenous Fistula of the Filum Terminale

Neurosurgery ◽

10.1227/01.neu.0000359529.40577.a1 ◽

2010 ◽

Vol 66 (1) ◽

pp. E219-E220 ◽

Cited By ~ 25

Author(s):

Yong Jun Jin ◽

Ki-Jeong Kim ◽

O Ki Kwon ◽

Sang Ki Chung

Keyword(s):

Arteriovenous Fistula ◽

Transarterial Embolization ◽

Conus Medullaris ◽

Leg Pain ◽

Anterior Spinal Artery ◽

Filum Terminale ◽

Segmental Artery ◽

First Case ◽

History Of ◽

The Right

Abstract OBJECTIVE Although a dural or intramedullary arteriovenous fistula involving the conus medullaris and fed by the lateral sacral artery has been reported, a case of perimedullary fistula arising from an artery in the filum terminale has not been described in the literature. The authors report the first case of perimedullary arteriovenous fistula located in the filum terminale. CLINICAL PRESENTATION A 61-year-old man presented with a 10-year history of leg pain. Thoracolumbar magnetic resonance imaging scans revealed multiple perimedullary signal voids from T10 to L3. Angiography showed engorged perimedullary veins and a fistula fed by the anterior spinal artery from the right ninth segmental artery and by 2 branches of the left lateral sacral artery. The anterior spinal artery was also regarded as the artery of the filum terminale. INTERVENTION Transarterial embolization was performed to occlude the feeders from the left lateral sacral artery, and an L5 total laminectomy was subsequently performed to obliterate residual fistulous material from the artery of the filum terminale. The thickened, yellowish filum, surrounded by tortuous, engorged veins, was coagulated and resected. Postoperatively, the patient's symptoms gradually resolved and were not aggravated during long periods of walking. CONCLUSION It must be noted that a fistula can be located in the filum terminale and can be successfully treated using multidisciplinary approaches.

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