Pre-operative Embolization of Intracranial and Extracranial Tumors: a Review of 37 Cases
Iampreechakul, P.; Tirakotai, W.; Lertbutsayanukul, P.; Siriwimonmas, S.; Liengudom, A.
Journal of the Medical Association of Thailand 99(Suppl 3): S91-119
2016
ISSN/ISBN: 0125-2208 PMID: 29901350 Document Number: 17471
To examine the safety and efficacy of pre-operative embolization of intra-and extracranial tumors and determine the selection criteria of patients for this procedure. Between June 2008 and August 2012, 37 patients (17 males, 20 females; mean age, 44.2+14.2years), underwent pre-operative embolization of intra- and extracranial tumors, were retrospectively reviewed. Tumor characteristics (type, location, volume, percentage of supplying artery, presence of an early draining vein), angiographic extent of tumor devascularization, timing between embolization and surgery, estimated blood loss, and complication related embolization were evaluated. There were 37 tumors (mean volume, 90.9+83.6 cm3) composed of 18 meningiomas, six hemangioblastomas, six hemangiopericytomas, one metastasis, one osteoblastoma, one osteosacroma, one neurofibroma, one central neurocytoma, one glomus jugulare, one mixed oligoastrocytoma, and one glioblastoma multiforme. Early of draining veins were visualized in 24 patients (64.9%). Failure of pre-operative embolization occurred in four patients. Median time to surgery after Although pre-operative embolization of intra- and extracranial tumors was safe, only extensive or complete angiographic devascularization has been effective in less intra-operative blood loss. From this present study, indications regarding when to perform pre-operative embolization include history of excessive bleeding from previous surgery, known hypervascular tumor types (e.g., hemangiopericytoma, hemangioblastoma, paraganglioma), the presence of multiple flow voids on MRI, hypervascular tumors of skull or scalp, deep-seated tumors (e.g., cranial base tumor, intraventricular tumor) with difficulty in early surgical access of the main feeding vessels, and tumors associated with intratumoral aneurysm.