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Wang AS, Murnin JC, Wiginton Iv J, Tchalukov K, Stout CE, Duong J, Sweiss R. Pre-operative Embolization of a Cerebellar Hemangioblastoma Using Polyvinyl Alcohol (PVA) and Target Tetra 360 Detachable Coil. Cureus 2024; 16:e56891. [PMID: 38659508 PMCID: PMC11042672 DOI: 10.7759/cureus.56891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/23/2024] [Indexed: 04/26/2024] Open
Abstract
Due to its hypervascularity, hemangioblastoma, a rare primary central nervous system intracranial tumor, has been treated with pre-operative embolization prior to surgical resection. Here, we describe a case treated as such. A 37-year-old male presented with worsening chronic headache and right ear tinnitus was found to have a hypervascular, heterogeneous right cerebellar lesion suspicious for arteriovenous malformation or hemangioblastoma. He underwent polyvinyl alcohol (PVA) and Target Tetra 360 (Fremont, CA: Stryker Neurovascular) detachable coil embolization followed by complete tumor resection. Pathology was consistent with hemangioblastoma. He presented with complete resolution of his symptoms immediately post-operatively and at a two-week follow-up. Our case highlighted the importance of pre-operative embolization to help achieve complete tumor resection which is considered curative in the treatment of hypervascular hemangioblastoma. The Target Tetra 360 detachable coil embolization is another material that can be considered.
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Affiliation(s)
- Alice S Wang
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - John C Murnin
- Medicine, Burrell College of Osteopathic Medicine, Las Cruces, USA
| | - James Wiginton Iv
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Konstantin Tchalukov
- Radiology, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Charles E Stout
- Neurointerventional Radiology, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Jason Duong
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
| | - Raed Sweiss
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
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Bauman MM, Bouchal SM, Kerezoudis P, Cloft H, Brinjikji W, Peris Celda M, Link MJ, Parney IF. Embolization of Large and Giant Posterior Fossa Hemangioblastomas: The Experience of a Single Tertiary Care Center. J Neurol Surg B Skull Base 2023; 84:598-608. [PMID: 37854530 PMCID: PMC10581830 DOI: 10.1055/a-1946-4604] [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: 07/15/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022] Open
Abstract
Background Hemangioblastomas pose an inherent surgical risk due to the potential for high intraoperative blood loss, especially in larger tumors. One approach to minimize this risk is to use preoperative embolization. Herein, we present our institutional experience treating large and giant cerebellar hemangioblastomas. Methods We performed a retrospective chart review of 19 patients with cerebellar hemangioblastomas that had a maximal diameter of >3 cm. We performed a literature review and included individual patient-level data that met our >3 cm diameter cerebellar hemangioblastoma inclusion criteria. Results Our cohort consisted of 19 patients that received a total of 20 resections for their cerebellar hemangioblastomas. Preoperative embolization was utilized in eight cases (38.1%). One patient experienced transient neurological complications after embolization (12.5%). Tumors of patients in the embolization group had larger median total, solid, and cystic volumes and were more likely to involve the cerebellopontine angle than those in the non-embolized group. Compared with non-embolized patients, embolized patients had less decrease in their hemoglobin, lower volumes of estimated blood loss, reduced rates of postoperative complications and permanent deficits, and greater instances of neurological improvement. The larger cohort (obtained from the combining our cohort with patients identified during a literature review) consisted of 99 patients with 39 receiving preoperative embolization. Conclusion It is important to examine individual patient characteristics when determining eligibility for preoperative embolization. However, improvements in endovascular techniques have made preoperative embolization a safe and effective procedure with minimal risks that can be performed in many patients.
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Affiliation(s)
- Megan M.J. Bauman
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Samantha M. Bouchal
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | | | - Harry Cloft
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Maria Peris Celda
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J. Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Ian F. Parney
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
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Palavani LB, Andreão FF, de Abreu LV, Batista S, Borges J, Oliveira LDB, Bertani R, Filho JAA. Assessing the efficacy and safety of hemangioblastoma embolization: A comprehensive systematic review and meta-analysis. J Clin Neurosci 2023; 117:104-113. [PMID: 37788533 DOI: 10.1016/j.jocn.2023.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/16/2023] [Accepted: 09/24/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Hemangioblastomas (HBs) are highly vascular tumors linked to substantial morbidity and mortality. Recently, interventional neuroradiology has evolved rapidly, spurring interest in preoperative embolization as a possible HB treatment. PURPOSE This study evaluates the effectiveness and safety of preoperative embolization in managing HB. METHODS Adhering to PRISMA guidelines, this meta-analysis considered randomized and nonrandomized studies meeting specific criteria, encompassing intracranial HB and preoperative embolization. Primary outcomes were preoperative embolization efficacy and safety. Complications were classified as major (cerebellar ischemia, ischemic strokes, intratumoral hemorrhage, subarachnoid hemorrhage) and minor (transient nystagmus, slight facial nerve palsy, nausea, transient dysarthria, hemiparesis, hemisensory impairment, thrombotic complications, extravasation). RESULTS Thirteen studies involving 166 patients with preoperative embolization before HB resection were included. Two studies using the Glasgow Outcome Scale (GOS) showed 5 patients with good recovery, 6 with moderate disability, and 3 with severe disability. Major complications occurred in 1% (95% CI: 0% to 3%), and minor complications occurred in 1% (95% CI: 0% to 4%). Intraoperative blood loss during resection was estimated at 464.29 ml (95% CI: 350.63 ml to 614.80 ml). CONCLUSION Preoperative embolization holds promise in reducing intraoperative bleeding risk in neurosurgical intracranial HB treatment, primarily due to its low complication rates. Nonetheless, additional research and larger-scale studies are essential to establish its long-term efficacy and safety. These findings highlight preoperative embolization as a valuable tool for HB management, potentially enhancing future patient outcomes.
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Affiliation(s)
| | - Filipi Fim Andreão
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, Brazil.
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Huisman TAGM, Patel R, Kralik S, Desai NK, Meoded A, Chen K, Weiner HL, Curry DJ, Lequin M, Kranendonk M, Orman G, Jallo G. Advances in Imaging Modalities for Pediatric Brain and Spinal Cord Tumors. Pediatr Neurosurg 2023; 58:240-258. [PMID: 37604135 DOI: 10.1159/000531998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/05/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Neuroimaging has evolved from anatomical imaging toward a multi-modality comprehensive anatomical and functional imaging in the past decades, important functional data like perfusion-weighted imaging, permeability imaging, diffusion-weighted imaging (DWI), and diffusion tensor imaging (DTI), tractography, metabolic imaging, connectomics, event-related functional imaging, resting state functional imaging, and much more is now being offered. SUMMARY Precision diagnostics has proven to be essential for precision treatment. Many minimal invasive techniques have been developed, taking advantage of digital subtraction angiography and interventional neuroradiology. Furthermore, intraoperative CT and/or MRI and more recently MR-guided focused ultrasound have complemented the diagnostic and therapeutic armamentarium. KEY MESSAGES In the current manuscript, we discuss standard imaging sequences including advanced techniques like DWI, DTI, susceptibility-weighted imaging, and 1H magnetic resonance spectroscopy, various perfusion weighted imaging approaches including arterial spin labeling, dynamic contrast enhanced imaging, and dynamic susceptibility contrast imaging. Pre-, intra, and postoperative surgical imaging including visualize imaging will be discussed. The value of connectomics will be presented for its value in neuro-oncology. Minimal invasive therapeutic possibilities of interventional neuroradiology and image-guided laser ablation and MR-guided high-intensity-focused ultrasound will be presented for treatment of pediatric brain and spinal cord tumors. Finally, a comprehensive review of spinal cord tumors and matching neuropathology has been included.
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Affiliation(s)
- Thierry A G M Huisman
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Rajan Patel
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Stephen Kralik
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Nilesh K Desai
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Avner Meoded
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Karen Chen
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Howard L Weiner
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel J Curry
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Maarten Lequin
- Department of Radiology, Wilhelmina Children's Hospital and Princess Maxima Center for Pediatric Oncology University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mariette Kranendonk
- Department of Pathobiology, Princess Maxima Center for Pediatric Oncology University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gunes Orman
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA,
| | - George Jallo
- Department of Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
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Boutakioute B, Zouine Y, Chehboun A, Ouali M, Ganouni NCIE. Successful preoperative embolization of a cystic-solid variant of cerebellopontine angle hemangioblastoma. Radiol Case Rep 2022; 17:4799-4803. [PMID: 36212759 PMCID: PMC9535285 DOI: 10.1016/j.radcr.2022.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 11/01/2022] Open
Abstract
Tumors of the cerebellopontine angle (CPA) represent an heterogeneous group which can arise extradural, intradural-extraaxial or intraaxial compartment. Hemangioblastomas of the cerebellopontine angle (CPA) are extremely rare. Computed tomography (CT) and magnetic resonance imaging (MRI) are often the gold-standard radiological imaging modalities used in characterizing the lesion's features, and its relationship with the surrounding structures. They are vascular lesions and may cause profuse bleeding intraoperatively, that is why angiography remains a crucial diagnostic and therapeutic tool, by reducing both the presurgical differential diagnosis, as well as the intraoperative bleeding by providing capability of embolization of this vascular tumor. We present the case of a 65 year old patient with a cystic-solid variety of HMB at the right CPA, which was successfully treated by a combination of an endovascular preoperative embolization and surgery without major complications or neurological deficits.
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Singh PR, Sharma RK, Chaturvedi J, Nayak N, Sharma AK. Surgical Outcome of Large Solid Posterior Fossa Hemangioblastoma without Preoperative Embolization. J Neurol Surg A Cent Eur Neurosurg 2021; 83:224-230. [PMID: 34433222 DOI: 10.1055/s-0041-1728766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Large solid hemangioblastoma in the posterior fossa has an abundant blood supply as an arteriovenous malformation. The presence of adjacent vital neurovascular structures makes them vulnerable and difficult to operate. Complete surgical resection is always a challenge to the neurosurgeon. MATERIAL AND METHOD We share the surgical difficulties and outcome in this case series of large solid hemangioblastomas without preoperative embolization as an adjunct. This study included five patients (three men and two women, with a mean age of 42.2 years). Preoperative embolization was attempted in one patient but was unsuccessful. All the patients have headache (100%) and ataxia (100%) as an initial symptom. A ventriculoperitoneal shunt was inserted in one case before definite surgery due to obstructive hydrocephalus. The surgical outcome was measured using the Karnofsky Performance Status (KPS) score. RESULT The tumor was excised completely in all the cases. No intra- and postoperative morbidity occurred in four patients; one patient developed transient lower cranial nerve palsy. Mean blood loss was 235 mL, and no intraoperative blood transfusion was needed in any case. The mean follow-up period was 14.2 months. The mean KPS score at last follow-up was 80.One patient had a KPS score of 60. CONCLUSION Our treatment strategy is of circumferential dissection followed by en bloc excision, which is the optimal treatment of large solid hemangioblastoma. The use of adjuncts as color duplex sonography and indocyanine green video angiography may help complete tumor excision with a lesser risk of complication. Preoperative embolization may not be needed to resect large solid posterior fossa hemangioblastoma, including those at the cerebellopontine angle location.
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Affiliation(s)
| | | | | | - Nitish Nayak
- Department of Neurosurgery, AIIMS, Raipur, Chhattisgarh, India
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Shinya T, Nagamine H, Sugawara KI, Ishiuchi S. The usefulness of indocyanine green during surgery for hypervascular posterior fossa tumors. Surg Neurol Int 2018; 9:90. [PMID: 29770250 PMCID: PMC5938893 DOI: 10.4103/sni.sni_19_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/02/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Cerebral hemangioblastomas are benign tumors with abundant blood flow that occur mainly in the posterior fossa. Tumor removal en bloc is important in surgical treatment because of the risk of bleeding; however, it is actually rather difficult in practice. Therefore, we propose a surgical strategy for visualizing hypervascular tumors of the posterior fossa utilizing indocyanine green (ICG). CASE DESCRIPTION Case 1 involved a 48-year-old male with a history of von Hippel-Lindau (VHL) disease. Magnetic resonance imaging (MRI) revealed a solid tumor measuring 3.0 cm in diameter in the right cerebellopontine angle. We performed surgery because the tumor was pressing against the brainstem. Surgery was performed via the posterior subtemporal transtentorial approach in order to visualize the feeding artery and draining vein intraoperatively. The vessels were confirmed by ICG and the tumor was removed en bloc. Case 2 involved a 30-year-old woman. Signs of increased intracranial pressure were noted, and an MRI revealed a solid tumor 3.5 cm in diameter in the left cerebellar hemisphere. Surgery was performed via the midline suboccipital approach. Similarly, we confirmed the vessels using ICG and the tumor was removed en bloc. CONCLUSIONS For hypervascular tumors of the posterior fossa, preoperative image assessment is important. Furthermore, the use of ICG during surgery is advantageous for surgical strategies where the feeding arteries and draining veins exist superficially in the operative field and are therefore easier to remove en bloc.
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Affiliation(s)
- Takahiro Shinya
- Department of Neurosurgery, University of the Ryukyus Faculty of Medicine Hospital, Okinawa, Japan
| | - Hideki Nagamine
- Department of Neurosurgery, University of the Ryukyus Faculty of Medicine Hospital, Okinawa, Japan
| | - Ken-ichi Sugawara
- Department of Neurosurgery, University of the Ryukyus Faculty of Medicine Hospital, Okinawa, Japan
| | - Shogo Ishiuchi
- Department of Neurosurgery, University of the Ryukyus Faculty of Medicine Hospital, Okinawa, Japan
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Eskey CJ, Meyers PM, Nguyen TN, Ansari SA, Jayaraman M, McDougall CG, DeMarco JK, Gray WA, Hess DC, Higashida RT, Pandey DK, Peña C, Schumacher HC. Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e661-e689. [PMID: 29674324 DOI: 10.1161/cir.0000000000000567] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intracranial endovascular interventions provide effective and minimally invasive treatment of a broad spectrum of diseases. This area of expertise has continued to gain both wider application and greater depth as new and better techniques are developed and as landmark clinical studies are performed to guide their use. Some of the greatest advances since the last American Heart Association scientific statement on this topic have been made in the treatment of ischemic stroke from large intracranial vessel occlusion, with more effective devices and large randomized clinical trials showing striking therapeutic benefit. The treatment of cerebral aneurysms has also seen substantial evolution, increasing the number of aneurysms that can be treated successfully with minimally invasive therapy. Endovascular therapies for such other diseases as arteriovenous malformations, dural arteriovenous fistulas, idiopathic intracranial hypertension, venous thrombosis, and neoplasms continue to improve. The purpose of the present document is to review current information on the efficacy and safety of procedures used for intracranial endovascular interventional treatment of cerebrovascular diseases and to summarize key aspects of best practice.
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Akinduro OO, Mbabuike N, ReFaey K, Yoon JW, Clifton WE, Brown B, Wharen RE, Quinones-Hinojosa A, Tawk RG. Microsphere Embolization of Hypervascular Posterior Fossa Tumors. World Neurosurg 2018; 109:182-187. [DOI: 10.1016/j.wneu.2017.09.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 11/16/2022]
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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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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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Safety and outcomes of preoperative embolization of intracranial hemangioblastomas: A systematic review. Clin Neurol Neurosurg 2016; 150:143-151. [PMID: 27668858 DOI: 10.1016/j.clineuro.2016.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/05/2016] [Accepted: 09/18/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION While preoperative embolization is often reserved for large and highly vascular tumors in order to minimize blood loss, its safety and efficacy in the treatment of hemangioblastomas (HB) is unclear. We present the largest systematic review focusing on the safety and outcome of preoperative embolization of intracranial HB. MATERIALS AND METHODS To identify all cases of preoperative embolization for HB, a literature search was conducted via Medline (OVID and PubMed), Scopus, Embase, and Web of Science. Studies that were in English, included intracranial hemangioblastomas treated with preoperative embolization and provided sufficient disaggregated clinical data for each patient were included. Historical control patients with non-embolized intracranial HB undergoing resection were similarly identified. RESULTS A total of 111 patients that underwent preoperative embolization of HB prior to planned resection were identified. Patient age ranged from 12 to 72 years, with a cohort of 63% males and 36% females. Nine studies comprising 392 non-embolized patients were included as controls. Gross total resection was achieved in 83.7% of embolized and 95.6% of non-embolized patients. Intraoperative blood transfusion was required in 15.3% of embolized and 0.51% of non-embolized controls, while rates of post-operative hemorrhage were 8.4% and 1.6%, respectively. Complication rates from embolization were 11.7% and following consequent surgery were 20.7%. DISCUSSION Embolization did not increase rates of gross total resection, decrease estimated blood loss, or decrease incidence of complications. Not only does embolization fail to mitigate surgical risks, the embolization procedure itself carries significant risk for complications. Embolization should not be standard of care for intracranial HB.
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The analysis of correlative factors affecting long-term outcomes in patients with Solid Cerebellar Hemangioblastomas. Clin Neurol Neurosurg 2016; 150:59-66. [PMID: 27588372 DOI: 10.1016/j.clineuro.2016.08.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/26/2016] [Accepted: 08/27/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Analyze the factors affecting postoperative outcomes in patients with solid cerebellar hemangioblastomas. PATIENTS AND METHODS We retrospectively analyzed the clinical data of 22 patients with sporadic solid cerebellar hemangioblastomas. Data regarding the clinical materials and imaging features, diameter of the lesion, operative approaches and postoperative complications were analyzed in all patients. The factors that may affect the recovery of postoperative patients were analyzed by univariate analysis and logistic regression multivariate analysis. RESULTS All 22 patients were diagnosed with sporadic solid cerebellar hemangioblastomas; total resection was achieved in 21 of 22 patients (95.5%). Six patients with combined obstructive hydrocephalus received a ventricle-peritoneal shunt preoperatively. The mean duration of the follow-up period was 25.5 months (range, 6-72 months). Tumor recurrence occurred in two patients with poor prognosis at 12 months and 56 months after surgery. According to outcome, patients were divided into the poor group (4 of 22 patients, 18.2%), in which neurological symptoms persisted postoperatively, or were worse than preoperatively, and the good group (18 of 22 patients, 81.8%) with no neurological signs or improved symptoms postoperatively. After univariate analysis, the factor affecting the final outcome was postoperative hemorrhage (P=0.003). Moreover, multiple logistic regression analysis via R software indicated that postoperative hemorrhage (p=0.008) was correlated with outcomes. CONCLUSIONS Postoperative hemorrhage is a factor correlated with final outcomes of patients with sporadic solid cerebellar hemangioblastomas.
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Supratentorial leptomeningeal hemangioblastoma resection after tumor embolization. FORMOSAN JOURNAL OF SURGERY 2016. [DOI: 10.1016/j.fjs.2016.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Sultan A, Hassan T, Aboul-Enein H, Mansour O, Ibrahim T. The value of preoperative embolization in large and giant solid cerebellar hemangioblastomas. Interv Neuroradiol 2016; 22:482-8. [PMID: 26934897 DOI: 10.1177/1591019916633244] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 01/25/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Solid cerebellar hemangioblastomas are highly vascular lesions and may cause catastrophic hemorrhage during excision. METHODS This retrospective study enrolled 10 patients (7 men and 3 women, with a mean age of 38.2 ± 12.5 years) with solid cerebellar hemangioblastomas. All patients had a solitary tumor and underwent surgical resection of the lesion through a suboccipital approach. The basic features, serial radiographic examinations, and operative records were analyzed. RESULTS The most common presenting symptoms were headache (100%), ataxia (100%), and long tract manifestations (60%). Three patients had experienced failed surgery previously due to massive intraoperative bleeding. Three patients were confirmed as having Von Hippel-Lindau disease. The average size of the tumor was 40.7 ± 8.7 mm in its maximal diameter (range 25-58 mm). Total endovascular occlusion obtained in six patients, near total occlusion in three patients, and incomplete occlusion in one patient. Nine (90.0%) patients underwent gross total resection and one (10.0%) underwent partial resection. After the primary surgery, eight (80.0%) patients experienced improvement in their symptoms, two (20.0%) maintained their pre-treatment status, and none showed neurological deterioration following tumor resection. Blood loss during surgery after embolization was minimal and controllable. CONCLUSION Preoperative embolization improves safety and efficacy of the microsurgical excision of such tightly located very vascular tumors. Embolization changes the concept of this lesion surgery into piecemeal removal rather than a total mass extraction technique. Liquid agents are superior to particles in obliteration of such lesions.
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Affiliation(s)
- Ahmed Sultan
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt
| | - Tamer Hassan
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt
| | - Hisham Aboul-Enein
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt
| | - Osama Mansour
- The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt Department of Interventional Neurology, Alexandria University School of Medicine, Egypt
| | - Tamer Ibrahim
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt
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