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Scarcia L, Kalamarides M, Shotar E, Premat K, Drir M, Sourour N, Clarençon F. Direct puncture embolization of a medulla oblongata hemangioblastoma. J Neuroradiol 2024; 51:254-255. [PMID: 37993097 DOI: 10.1016/j.neurad.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 11/24/2023]
Abstract
Hemangioblastoma is a rare tumor of vascular origin, most commonly located in the posterior fossa, which presents with severe symptoms and usually very hard to resect without remarkable operative blood loss.1-2 Pre-operative embolization may decrease the amount of intra-operative bleeding, but the endovascular treatment of such tumor may be very challenging due to the high risk of infarction of the surrounding tissues. Direct puncture embolization has been developed to overcome many of the limitations of endovascular techniques for many hypervascular lesions, also hemangioblastomas.3-5 We present in this Technical Video (video 1) a direct puncture embolization with balloon-protection of a hemangioblastoma of the medulla oblongata using Onyx 18 (Medtronic, inc.) as sole liquid embolic agent.
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Affiliation(s)
- Luca Scarcia
- Department of Neuroradiology, Henri Mondor Hospital, Creteil, France.
| | - Michel Kalamarides
- Neurosurgery Department, Pitié-Salpêtrière, APHP, Sorbonne University, Paris, France
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital. Paris, France
| | - Kevin Premat
- Department of Neuroradiology, Pitié-Salpêtrière Hospital. Paris, France
| | - Mehdi Drir
- Department of Anesthesiology and Neuro-intensive care, Sorbonne University, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Nader Sourour
- Department of Neuroradiology, Pitié-Salpêtrière Hospital. Paris, France
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital. Paris, France; GRC BioFast, Sorbonne University, Paris, France
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2
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Li P, Tian Y, Song J, Yang Z, Zou X, Liu P, Zhu W, Chen L, Mao Y. Microsurgical intracranial hypervascular tumor resection immediately after endovascular embolization in a hybrid operative suite: A single-center experience. J Clin Neurosci 2021; 90:68-75. [PMID: 34275583 DOI: 10.1016/j.jocn.2021.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/29/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study was performed to investigate the safety and outcome of one-stage hybrid endovascular and microsurgical treatment of intracranial hypervascular tumors. METHODS The blood supply of the tumor was endovascularly embolized just before microsurgery in a one-stage fashion. Clinical data regarding the preoperative neurological status, tumor characteristics, hybrid treatment details and complications, intraoperative blood loss, and postoperative outcomes were collected prospectively and then analyzed. RESULTS Beginning in July 2016, 13 patients (5 women, 8 men) with intracranial hypervascular tumors were enrolled in this study, with a mean age of 48.2 ± 10.9 years. The patients' tumors comprised seven hemangioblastomas, three hemangiopericytomas, two meningiomas, and one mesenchymal chondrosarcoma. The mean maximum tumor diameter was 54.9 ± 21.5 mm. No major procedural complications occurred except catheterization-related bleeding in one patient. The mean percentage of tumor devascularization was 65.0%±17.5%. Gross total resection was achieved in 12 patients (92.3%). The mean blood loss volume during microsurgical resection was 703.8 ± 886.8 mL (range, 150-3600 mL). Symptoms improved in three patients and remained stable in six patients. CONCLUSIONS One-stage hybrid embolization before intracranial hypervascular tumor resection is a safe and effective procedure to decrease intraoperative blood loss. It can prevent or treat embolization-related complications in a timely manner and avoid the risk of multiple surgical procedures.
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Affiliation(s)
- Peiliang Li
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanlong Tian
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianping Song
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zixiao Yang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiang Zou
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Peixi Liu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei Zhu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Medical Neurobiology, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai 200032, China
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Buell TJ, Starke RM, Ding D, Hixson HR, Raper DMS, Chen CJ, Liu KC. Venous Sinus Stenting using Transcranial Access for the Treatment of Idiopathic Intracranial Hypertension in a Pediatric Patient. J Neurosci Rural Pract 2019; 8:672-675. [PMID: 29204038 PMCID: PMC5709901 DOI: 10.4103/jnrp.jnrp_135_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
A 4-year-old male with headaches, papilledema, intracranial hypertension, and bilateral transverse sinus (TS) stenosis underwent attempted percutaneous placement of a right TS stent. Stent deployment was not technically feasible due to the stiffness of the stent and tortuosity of the patient's jugular bulb. Therefore, the patient underwent hybrid endovascular stenting of the right TS using neuronavigation and direct access of the TS following a single burr hole craniectomy. Two Express 8 mm × 17 mm balloon-mounted stents were deployed into the right TS, which resulted in obliteration of the preexisting trans-stenosis pressure gradient and decreased intracranial parenchymal pressure as monitored through an intracranial pressure bolt. The patient's headaches and papilledema resolved, and follow-up imaging demonstrated no in-stent or stent-adjacent stenosis. This case demonstrates the feasibility of combining minimally invasive open surgical access to allow direct cannulation for venous sinus stenting.
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Affiliation(s)
- Thomas J Buell
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Robert M Starke
- Department of Neurosurgery and Radiology, University of Miami, Miami, FL, USA
| | - Dale Ding
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Harry R Hixson
- Department of Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Daniel M S Raper
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Kenneth C Liu
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA.,Department of Radiology, University of Virginia Health System, Charlottesville, VA, USA
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4
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Kuharic M, Jankovic D, Splavski B, Boop FA, Arnautovic KI. Hemangioblastomas of the Posterior Cranial Fossa in Adults: Demographics, Clinical, Morphologic, Pathologic, Surgical Features, and Outcomes. A Systematic Review. World Neurosurg 2017; 110:e1049-e1062. [PMID: 29229339 DOI: 10.1016/j.wneu.2017.11.173] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 12/09/2022]
Abstract
BACKGROUND Posterior cranial fossa (PCF) hemangioblastomas are benign, highly vascularized, and well-differentiated tumors with well-described histopathologic features. Although relatively rare, this tumor is the most prevalent primary tumor of the cerebellum in adults. OBJECTIVE Because the demographics of patients with such a tumor (as well as the clinical, morphologic, pathologic, surgical features, and outcomes) are not fully understood, we systematized characteristic patient and tumor features. METHODS We undertook a systematic review of the English-language literature in PubMed for PCF hemangioblastomas in adults published in the past 31 years. We analyzed geographic distribution and year of publication of articles; demographic data of patients; presenting symptoms and clinical signs; tumor location and morphology; histopathologic features, extent of tumor resection, perioperative blood loss, and postoperative complications; length of hospital stay; and outcomes. RESULTS We reviewed 207 articles describing 1759 infratentorial hemangioblastomas in a cohort of 1515 adult patients. We found female predominance in patients with Von Hippel-Lindau disease (VHLD) compared with male predominance in the general patient group. Symptoms of intracranial hypertension were more common in the VHLD group compared with the general group of patients. The cerebellar location was more common in the VHLD group and solid (parenchymatous) tumor was the most common type. Most patients underwent total resection but rate of resection did not differ between the general and VHLD groups. Most patients had a favorable outcome. CONCLUSIONS The literature of adult PCF hemangioblastomas is limited and general surgical experience with such tumors is scarce because of their rarity. Rates of postoperative complications and mortality remain higher than expected. However, prognosis and surgical outcomes are generally favorable. Nevertheless, surgery of adult PCF hemangioblastomas is a demanding and challenging task.
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Affiliation(s)
- Marin Kuharic
- Osijek University School of Medicine, Osijek, Croatia
| | | | - Bruno Splavski
- Osijek University School of Medicine, Osijek, Croatia; Department of Neurosurgery, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Frederick A Boop
- Semmes-Murphey Clinic, Memphis, Tennessee, USA; Department of Neurosurgery, University of Tennessee School of Medicine, Memphis, Tennessee, USA
| | - Kenan I Arnautovic
- Semmes-Murphey Clinic, Memphis, Tennessee, USA; Department of Neurosurgery, University of Tennessee School of Medicine, Memphis, Tennessee, USA.
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Zhou MH, Dunn GP, Osbun JW, Cross DT, Moran CJ, Dacey RG, Kansagra AP. Direct puncture Onyx embolization of a large calvarial metastasis with intracranial extension: Case report. Interv Neuroradiol 2017; 24:220-224. [PMID: 29119877 DOI: 10.1177/1591019917740353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report a case of renal cell carcinoma (RCC) metastasis to the calvarium and describe a strategy for percutaneous embolization of hypervascular calvarial tumors with intracranial extension. An elderly patient with history of RCC presented with left-sided weakness. Imaging studies showed a large right frontoparietal calvarial mass with intra- and extracranial extension. The tumor was devascularized by direct puncture tumor embolization using Onyx 18, allowing subsequent operative resection without significant blood loss or the need for flap reconstruction of the scalp. Compared to more common endovascular approaches, direct-needle puncture embolization of transcalvarial masses may offer lower risk of injury to scalp vessels and underlying brain parenchyma.
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Affiliation(s)
- Minerva H Zhou
- 1 12275 School of Medicine, Washington University , St. Louis, MO, USA
| | - Gavin P Dunn
- 2 12275 Department of Neurological Surgery, Washington University , St. Louis, MO, USA.,3 Department of Pathology and Immunology, Washington University, St. Louis, MO, USA.,4 Center for Human Immunology and Immunotherapy Programs, Washington University, St. Louis, MO, USA
| | - Joshua W Osbun
- 2 12275 Department of Neurological Surgery, Washington University , St. Louis, MO, USA.,5 Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO, USA.,6 Department of Neurology, Washington University, St. Louis, MO, USA
| | - DeWitte T Cross
- 2 12275 Department of Neurological Surgery, Washington University , St. Louis, MO, USA.,5 Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO, USA
| | - Christopher J Moran
- 2 12275 Department of Neurological Surgery, Washington University , St. Louis, MO, USA.,5 Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO, USA
| | - Ralph G Dacey
- 2 12275 Department of Neurological Surgery, Washington University , St. Louis, MO, USA
| | - Akash P Kansagra
- 2 12275 Department of Neurological Surgery, Washington University , St. Louis, MO, USA.,5 Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO, USA.,6 Department of Neurology, Washington University, St. Louis, MO, USA
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Yanez N, Cifuentes LK, Mejia M, Useche JN. Advantages of using a detachable-tip microcatheter and liquid embolic agents in the preoperative embolization of a recurrent cerebellar hemangioblastoma: A case report. Surg Neurol Int 2017; 8:239. [PMID: 29026675 PMCID: PMC5629862 DOI: 10.4103/sni.sni_123_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/24/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The preferred treatment for intracranial hemangioblastomas is surgical resection with or without preoperative embolization, however, embolization remains controversial due to risks such as distal tip entrapment, vascular injury during navigation, and embolic agent migration. CASE DESCRIPTION A 54-year-old woman was admitted for surgical resection and preoperative embolization of a cerebellar hemangioblastoma. Although experience using Onyx with detachable and nondetachable tip microcatheters has been well reported in a variety of clinical circumstances, we describe the first case of a presurgical embolization of an intra-axial tumor using a second-generation detachable-tip microcatheter and a nonadhesive liquid embolic agent. Following the procedure, a nearly complete angiographic obliteration was achieved, as well as a successful subsequent surgical resection. CONCLUSION Preoperative embolization with detachable-tip microcatheters and liquid embolic agents should be taken into consideration when assessing patients with hemangioblastomas of the posterior fossa due to the reduced risks of cardiac arrest, hemorrhage, and death.
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Affiliation(s)
- Nicolas Yanez
- School of Medicine, Universidad de los Andes, Bogota DC, Colombia.,Department of Diagnostic and Interventional Imaging, Hospital Universitario Fundacion Santa Fe de Bogota, Bogota DC, Colombia
| | - Luisa K Cifuentes
- Department of Diagnostic and Interventional Imaging, Hospital Universitario Fundacion Santa Fe de Bogota, Bogota DC, Colombia
| | - Marcela Mejia
- Department of Pathology, Hospital Universitario Fundacion Santa Fe de Bogota, Bogota DC, Colombia
| | - Juan N Useche
- Department of Diagnostic and Interventional Imaging, Hospital Universitario Fundacion Santa Fe de Bogota, Bogota DC, Colombia
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Ene CI, Xu D, Morton RP, Emerson S, Levitt MR, Barber J, Rostomily RC, Ghodke BV, Hallam DK, Albuquerque FC, McDougall CG, Sekhar LN, Ferreira M, Kim LJ, Chang SW. Safety and Efficacy of Preoperative Embolization of Intracranial Hemangioblastomas. Oper Neurosurg (Hagerstown) 2016; 12:135-140. [PMID: 29506092 DOI: 10.1227/neu.0000000000001014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 07/20/2015] [Indexed: 11/18/2022] Open
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.
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Affiliation(s)
- Chibawanye I Ene
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - David Xu
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Ryan P Morton
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Samuel Emerson
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Michael R Levitt
- Department of Radiology, University of Washington, Seattle Washington
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Robert C Rostomily
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Basavaraj V Ghodke
- Department of Neurological Surgery, University of Washington, Seattle, Washington.,Department of Radiology, University of Washington, Seattle Washington
| | - Danial K Hallam
- Department of Neurological Surgery, University of Washington, Seattle, Washington.,Department of Radiology, University of Washington, Seattle Washington
| | - Felipe C Albuquerque
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Cameron G McDougall
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Laligam N Sekhar
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Manuel Ferreira
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Louis J Kim
- Department of Neurological Surgery, University of Washington, Seattle, Washington.,Department of Radiology, University of Washington, Seattle Washington
| | - Steve W Chang
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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8
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Preoperative Embolization for Intracranial Meningiomas: Selecting Optimal Targets Based on Tumor Anatomy and Angioarchitecture. Clin Neuroradiol 2014; 25:327-8. [DOI: 10.1007/s00062-014-0317-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 06/14/2014] [Indexed: 10/25/2022]
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