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.

Endoscopically assisted intratumoral embolization of juvenile nasopharyngeal angiofibroma using Onyx

2011 ◽  
Vol 7 (6) ◽  
pp. 600-603 ◽  
Author(s):  
Mohammad Ali Aziz-Sultan ◽  
Roham Moftakhar ◽  
Stacey Quintero Wolfe ◽  
Mohamed Samy Elhammady ◽  
Björn Herman ◽  
...  
Keyword(s):  
Blood Loss ◽  
Embolic Agent ◽  
Vascular Tumors ◽  
Preoperative Embolization ◽  
Surgical Morbidity ◽  
Nasopharyngeal Angiofibroma ◽  
Liquid Embolic Agent ◽  
Endoscopic Guidance ◽  
Endoscopic Assistance ◽  
Embolic Materials

Juvenile nasopharyngeal angiofibromas are vascular tumors that may make resection difficult and potentially dangerous. Preoperative embolization is frequently used to decrease surgical morbidity and blood loss. Embolization has typically been performed via a transarterial route using a variety of embolic materials. The authors present a case in which endoscopic assistance was used for direct transnasal tumor puncture and intratumoral embolization using the liquid embolic agent Onyx. In this case there was excellent infiltration of the parenchymal vasculature with complete angiographic obliteration. There were no complications related to the embolization. The tumor was resected with minimal blood loss. To the authors' knowledge, there have been no previous reports of this novel direct intratumoral embolization technique using endoscopic guidance.

The effect of embolization with N-butyl cyanoacrylate prior to surgical resection of cerebral arteriovenous malformations

1993 ◽  
Vol 78 (1) ◽  
pp. 60-69 ◽  
Author(s):  
Jafar J. Jafar ◽  
Adam J. Davis ◽  
Alejandro Berenstein ◽  
In Sup Choi ◽  
Mark J. Kupersmith
Keyword(s):  
Blood Loss ◽  
Surgical Resection ◽  
Surgical Complications ◽  
Neurological Outcome ◽  
Arteriovenous Malformations ◽  
Operative Time ◽  
Preoperative Embolization ◽  
Intraoperative Blood Loss ◽  
Cerebral Arteriovenous Malformations ◽  
Significant Difference

✓ Endovascular therapy of cerebral arteriovenous malformations (AVM's) is an accepted adjunct to surgical therapy. However, the literature has not characterized the benefits or the liabilities of preoperative embolization. This series compares two groups of patients who underwent surgical resection of a cerebral AVM; one group (20 patients) received preoperative transfemoral selective embolization with N-butyl cyanoacrylate (NBCA) and the other group (13 patients) did not. In the group with preoperative embolization, the AVM's were larger (3.9 vs. 2.3 cm) and of a higher Spetzler-Martin grade (3.2 vs. 2.5) as compared to the nonembolized group. The NBCA embolization facilitated surgical resection. Arteries supplying the vascular malformation were readily distinguished from those supplying the normal brain parenchyma. Embolized vessels were compressible and easily cut with microscissors. No bleeding occurred from transected vessels. Operative time and intraoperative blood loss for the two groups were not statistically different, despite the significant differences in lesion size and grade. Endovascular complications included immediate and delayed hemorrhage (15%) and transient ischemia (5%); there were no embolization-related deaths. Postoperative complications for both groups included hemorrhage (15%), residual AVM (6%), and cerebrospinal fluid leak (3%); the mortality rate was 3%. There was no statistically significant difference in surgical complications between the embolized and nonembolized groups. Most patients (91%) in both groups had an excellent or good late neurological outcome, with no significant difference between the groups. This study concludes that preoperative NBCA embolization of AVM's makes lesions of larger size and higher grade the surgical equivalent of lesions of smaller size and lower grade by reducing operative time and intraoperative blood loss, with no statistically significant difference in surgical complications or long-term neurological outcome.

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.

Delayed Surgical Resection Reduces Intraoperative Blood Loss for Embolized Meningiomas

Neurosurgery ◽  
2002 ◽  
Vol 50 (6) ◽  
pp. 1231-1237 ◽  
Author(s):  
Jay Y. Chun ◽  
Michael W. McDermott ◽  
Kathleen R. Lamborn ◽  
Charles B. Wilson ◽  
Randall Higashida ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Surgical Resection ◽  
Tumor Resection ◽  
Optimal Time ◽  
Preoperative Embolization ◽  
Intraoperative Blood Loss ◽  
Tumor Removal ◽  
Duration Of Surgery ◽  
Delayed Group

Abstract OBJECTIVE Embolization before surgical resection of tumors has been demonstrated to reduce intraoperative blood loss, but the optimal time that should elapse between embolization and tumor resection has not been established. We evaluated whether immediate surgical resection (≤24 h) after embolization or delayed surgical resection (&gt;24 h) was more effective in minimizing intraoperative blood loss. METHODS We retrospectively analyzed the records for 50 patients with meningiomas who underwent preoperative embolization between 1993 and 1999. We divided the patients into two groups, i.e., those who underwent surgical resection of their meningiomas ≤24 hours after embolization and those who underwent surgery more than 24 hours after embolization. The extent of embolization, intraoperative blood loss, duration of surgery, and length of the hospital stay were compared for the two groups. Postoperative pathological specimens were examined for assessment of the extent of vascularity and necrosis caused by embolization. RESULTS Intraoperative blood loss was greater for the immediate group than for the delayed group (29% with blood loss of &gt;1000 ml [median, 475 ml] versus 0% with blood loss of &gt;700 ml [median, 337.5 ml];P = 0.01). There were no statistically significant differences between the groups with respect to tumor volume, extent of embolization, degree of devascularization, necrosis, duration of surgery, or length of the hospital stay. CONCLUSION Contrary to previous studies that emphasized a need for tumor removal immediately after embolization, to prevent revascularization, surgical resection of meningiomas should be delayed more than 24 hours after embolization, because there is less intraoperative blood loss.

scholarly journals Gross Total Resection of Large Cerebellopontine Angle Meningioma with a Supratentorial Extension via Retrosigmoid Approach with Suprameatal Drilling and Tentorial Sectioning

2018 ◽  
Vol 79 (S 05) ◽  
pp. S399-S401
Author(s):  
Sima Sayyahmelli ◽  
Adi Ahmetspahic ◽  
Mustafa Baskaya
Keyword(s):  
Surgical Resection ◽  
Cerebellopontine Angle ◽  
Surgical Techniques ◽  
Retrosigmoid Approach ◽  
World Health ◽  
Gross Total Resection ◽  
Total Resection ◽  
Facial Numbness ◽  
Magnetic Resonance Imaging Mri ◽  
Health Organization

Meningiomas are the second most common neoplasm in the cerebellopontine angle (CPA), and are challenging lesions to treat surgically. With significant refinements in surgical techniques, operative morbidity, and mortality have been substantially reduced. Total or near-total surgical resection can be accomplished in the majority of cases via appropriately selected approaches, and with acceptable morbidity. In this video, we present a 51-year-old woman, who had a 2-year history of vertigo with symptoms that progressed over time. She presented with blurry vision, sensorineural hearing loss, tinnitus, left-sided facial numbness, and double vision. Magnetic resonance imaging (MRI) showed a left-sided homogeneously enhancing mass at CPA with a supratentorial extension. MRI appearance was consistent with a CPA meningioma with supratentorial extension. The patient underwent surgical resection via a retrosigmoid approach. Suprameatal drilling and tentorial sectioning were necessary to achieve gross total resection. The surgery and postoperative course were uneventful. The histopathology was a WHO (world health organization) grade I meningioma. MRI showed gross total resection of the tumor. After a 1.5-year follow-up, the patient is continuing to do well with no residual or recurrent disease. In this video, microsurgical techniques and important steps for the resection of this challenging meningioma of the cerebellopontine angle are demonstrated.The link to the video can be found at: https://youtu.be/CDto52GxrG4.

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

2013 ◽  
Vol 18 (5) ◽  
pp. 450-455 ◽  
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.

Curative treatment for low-grade arteriovenous malformations

2019 ◽  
Vol 12 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Arthur Wang ◽  
Grace K Mandigo ◽  
Neil A Feldstein ◽  
Michael B Sisti ◽  
E Sander Connolly ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Functional Outcomes ◽  
Arteriovenous Malformations ◽  
Combined Treatment ◽  
Curative Treatment ◽  
Embolic Agent ◽  
Preoperative Embolization ◽  
Low Grade ◽  
The Mean

BackgroundSpetzler-Martin (SM) grade I-II (low-grade) arteriovenous malformations (AVMs) are often considered safe for microsurgery or radiosurgery. The adjunctive use of preoperative embolization to reduce surgical risk in these AVMs remains controversial.ObjectiveTo assess the safety of combined treatment of grade I-II AVMs with preoperative embolization followed by surgical resection or radiosurgery, and determine the long-term functional outcomes.MethodsWith institutional review board approval, a retrospective analysis was carried out on patients with ruptured and unruptured SM I-II AVMs between 2002 and 2017. Details of the endovascular procedures, including number of arteries supplying the AVM, number of branches embolized, embolic agent(s) used, and complications were studied. Baseline clinical and imaging characteristics were compared. Functional status using the modified Rankin Scale (mRS) before and after endovascular and microsurgical treatments was compared.Results258 SM I-II AVMs (36% SM I, 64% SM II) were identified in patients with a mean age of 38 ± 17 years. 48% presented with hemorrhage, 21% with seizure, 16% with headache, 10% with no symptoms, and 5% with clinical deficits. 90 patients (68%) in the unruptured group and 74 patients (59%) in the ruptured group underwent presurgical embolization (p = 0.0013). The mean number of arteries supplying the AVM was 1.44 and 1.41 in the unruptured and ruptured groups, respectively (p = 0.75). The mean number of arteries embolized was 2.51 in the unruptured group and 1.82 in the ruptured group (p = 0.003). n-Butyl cyanoacrylate and Onyx were the two most commonly used embolic agents. Four complications were seen in four patients (4/164 patients embolized): two peri-/postprocedural hemorrhage, one dissection, and one infarct. All patients undergoing surgery had a complete cure on postoperative angiography. Patients were followed up for a mean of 55 months. Good long-term outcomes (mRS score ≤ 2) were seen in 92.5% of patients with unruptured AVMs and 88.0% of those with ruptured AVMs. Permanent neurological morbidity occurred in 1.2%.ConclusionsCurative treatment of SM I-II AVMs can be performed using endovascular embolization with microsurgical resection or radiosurgery in selected cases, with very low morbidity and high cure rates. Compared with other published series, these outcomes suggest that preoperative embolization is a safe and effective adjunct to definitive surgical treatment. Long-term follow-up showed that patients with low-grade AVMs undergoing surgical resection or radiosurgery have good functional outcomes.

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.

Preoperative embolization of spinal tumors: variables affecting intraoperative blood loss after embolization

2012 ◽  
Vol 53 (8) ◽  
pp. 935-942 ◽  
Author(s):  
Katsuhiro Kobayashi ◽  
Efe Ozkan ◽  
Alda Tam ◽  
Joe Ensor ◽  
Michael J Wallace ◽  
...  
Keyword(s):  
Blood Loss ◽  
Spinal Tumors ◽  
Preoperative Embolization ◽  
Intraoperative Blood Loss

Interventional embolization of giant thoracic tumors before surgical resection

2013 ◽  
Vol 54 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Feng-Yong Liu ◽  
Mao-Qiang Wang ◽  
Qing-Sheng Fan ◽  
Feng Duan ◽  
Zhi-Jun Wang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Blood Loss ◽  
Polyvinyl Alcohol ◽  
Surgical Resection ◽  
Efficient Method ◽  
Preoperative Embolization ◽  
Patient Records ◽  
Operative Field ◽  
Feeding Vessels ◽  
Pva Particles

Background Preoperative embolization of tumors is a well-established procedure that has been successfully applied in various clinical situations. Preoperative embolization can reduce the vascularity of tumors resulting in a clearer operative field, less difficult dissection, decreased blood loss, and, in some cases, a decrease in tumor size. However, few studies have been conducted regarding the preoperative embolization of giant thoracic tumors. Purpose To examine the effectiveness and safety of interventional embolization of giant thoracic tumors before surgical resection. Material and Methods A total of 14 consecutive patients with giant thoracic tumors received angiography and the feeding arteries of the tumors were embolized using polyvinyl alcohol (PVA) particles and gelatin sponges 1 day before surgical resection. The patient records were retrospectively reviewed and data regarding diagnoses, embolization, and surgical resection were recorded. Results Angiography revealed the feeding arteries of the tumors to be characterized by multiple branches and thickened vessel trunks with abnormal distal branches superimposed of the tumor shadow. Embolization was successfully without complications in all patients, and all feeding vessels of each tumor were occluded. Embolization reduced the severity of bleeding during surgery and decreased the difficulty of resection of the tumor. No intraoperative or postoperative complications occurred. Conclusion Interventional embolization is a safe and efficient method to facilitate the surgical resection of giant thoracic tumors.

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