Improving Forward Infusion Pressure during Brain Tumor Embolization with the Double Catheter and Coil Technique / 신경중재치료의학

Endovascular embolization or embosurgery of brain tumors can be used to reduce neoplasm vascularity prior to surgical resection. Two challenges with embosurgery relate to insufficient perfusion pressure into the tumor and inadvertent escape of infused agents into parenchymal branches of the adjacent brain. This report describes a multi-catheter and coil technique to improve tumor perfusion and prevent reflux into normal branches.

The role of preoperative selective embolization for intracranial huge meningiomas / 重庆医学

Objective To explore the role of the preoperative DSA examination and selected embolization in surgical treatment of intracranial huge meningiomas .Methods The clinical materials of 13 patients was collected and analyzed .Preoperative DSA was carried out in all cases ,10 of 13 underwent selected preoperative embolization ,the meningiomas were totally excised by surgery 4 to 7 days after the embolization .Results After the embolization ,DSA showed that the blood fed to the tumors was completely blocked in 8 cases ,and in great part in 2 cases .All tumors were totally removed ,the bleeding during operation was significantly decreased in patients who underwent preoperative embolization compared to the patients without embolization (P<0 .05) .Necrosis in different degree of meningiomas was found in postoperative pathological examination .There were no severe complications occurred during and after operations in all patients .Conclusion Preoperative selective embolization could significantly decrease the bleeding during operations .

Embolização pré operatória no tratamento de paraganglioma abdominal: relato de caso / Pré-operative embolization of abdominal paraganglioma: case report

Paragangliomas is a pheochromocytoma of extra adrenal localization. The case report is a male, 55 years old who presented symptoms of adrenergic hyperstimulation associated to an abdominal mass diagnosed as paraganglioma by a biopsy. Because of its size, localization and vascularization, an aortography with embolization of the nutrient branches of the tumor was done pre-operatively. Four days later, a surgical ressection was performed, and the tumor was adhered to the duodenum, infra-renal aorta and inferior vena cava. We believe that an angiographic study pre-operatively with embolization makes possible an analysis of the anastomosis and arterial supplement, making the ressecability of the tumor safer, although it seems the surgical intervention should have been done earlier.

Surgery of a Solid Hemangioblastoma at the Cervicomedullary Junction

The surgical removal of solid deepseated hemangioblastomas remains challenging, because treatment of these lesions is often complicated by severe bleeding associated with the rich vascularity of this tumor, and by severe neural tissue injury associated with the difficulty of en bloc resection, especially when the tumor is located at the cervicomedullary junction. Therefore, preoperative embolization of deepseated solid hemangioblastomas may play an important role in successful surgical removal by reducing major bleeding and neural tissue damage. A 24-year-old woman, 28-weeks pregnant, was admitted to our hospital for the evaluation of quadriparesis, and brain magnetic resonance imaging(MRI) revealed intra-axial mass lesion in the cervicomedullary junction. After delivery, her neurologic symptoms became aggravated, and we decided to operate. Preoperative angiography revealed a hypervascular tumor in the posterior fossa, and embolization of the main feeding artery using gelfoam and microcoil, resulted in marked reduction of tumor vascularity. She underwent a midline suboccipital craniotomy involving the removal of the arch of C-1. The tumor was totally removed through a midline myelotomy, and at her 6-month follow-up she walked independently. We report on the combined use of the preoperative embolization of feeding vessels and subsequent operative resection in a patient with a solid hemangioblastoma at the cervicomedullary junction immediately after delivery.

Surgical Treatment of a Capillary Hemangioma with Preoperative Embolization

PURPOSE: To assess the effect of surgical excision of a capillary hemangioma with preoperative embolization. METHODS: An 8-month-old girl with large upper eyelid capillary hemangioma obscuring the visual axis which did not show any decrease in size of tumor mass after two steroid injections was referred to us. We treated this patient with preoperative embolization and surgical excision of the mass. RESULTS: We treated this patient successfully with preoperative embolization and surgical excision of the mass without considerable blood loss. No recurrences have been noted. CONCLUSIONS: Surgical excision of capillary hemangiomas with preoperative embolization should be considered a treatment option in large capillary hemangiomas that fail to respond to local corticosteroid injections.

Clinical significance of preoperative endovascular embolization in treatment of patients with vascularized me-ningioma / 介入放射学杂志

Objective To investigate the clinical efficacy and significance of preoperative superselective endovascular embolization in treatment of patients with vascularized meningioma.Methods 3-9 days before operation, 98 patients with vascularized meningioma underwent DSA and preoperative superselective embilization with PVA particles, gelatin sponge, and silk. The surgical intervention was performed after embolization. Results The vascularized meningioma was mainly supplied by the middle meningeal artery, ascending pharyngeal artery, occipital artery, internal maxillary artery as well as submeningeal artery. After the supplying artery was embolized, tumors' staining in 42 cases disappeared completely and that of 56 cases disappeared totally or partly. Most patients were operated on 3-9 days after embolization. 64 tumors were removed completely, while other 34 cases were removed totally or partly. The average volume of bleeding during the operation was 950 ml in the former and 1 500 ml in the latter.Conclusions The best time for operation is 7～9 days after embolization. Preoperative embolization of the vascularized meningioma contributes to reduce the bleeding significantly during the operation, increase the safety of the operation and improve the total removal of the tumor. It is a safe and effective microinvasive method.

Embolization and Surgical Treatment for Arteriovenous Malformation

An arteriovernous malformation (AVM) occurring in the eyelid and orbit grows in size if left untreated and causes cosmetic problems, but the AVM represents a treatment challenge because of its high-flow characteristics and involvement of several arteries. We examined two patients with AVM of the eyelid and orbit, which was confirmed by angiography and computed tomography. Treatment of each patient started with neuroradiologic embolization of the vascular lesion. A single procedure embolization was effective in one patient, but three embolizaiton procedures were needed in the other patient to get a satisfactory result because the lesion showed complex vascular association. Surgical excision was then performed in each management was only transient dyspnea in one patient. In managing AVM occurring in the eyelid an orbit, preoperative adjuvant embolization and surgical management could make inoperable lesions operable.

Intracranial Hemorrhage as a Complication of Preoperative Embolization for Brain Tumor: Report of Two Cases

Hemorrhage associated with an intracranial neoplasm is a rare event and can produce a serious outcome. Most of the intracranial hemorrhages in brain tumors are in the subarachnoid, intracerebral, or subdural area and cases of intratumoral or intraventricular hemorrhage are relatively rare. The authors report two cases of brain tumors associated with intratumoral and intraventricular hemorrhage which occurred during the preoperative embolization. The diagnoses were petro-clival hemangiopericytoma and suspected intraventricular meningioma. There was no specific precipitating factor for the bleeding. We discuss the possible mechanisms of intracranial hemorrhage in these cases, and stress the unexpected complication when performing preoperative embolization.

Clinical Study According to the Modality of Treatment of Cerebral Arteriovenous Malformations

A series of 44 patients with cerebral arteriovenous malformations(AVM's) treated by various modalities from January, 1987, to March, 1994, at Chung-Ang University Hospital were reviewed with emphasis on the outcome. Of these patients, 8 received conservative treatment, 16 only surgery, 4 combined embolization and surgery, and 16 embolization alone. The follow-up period ranged from 7 months to 54 months with a mean of 20.6 months. The efficacy of the combined treatment was evaluated by the complications and the clinical outcome. When compared with surgery alone, preoperative embolization facilitated surgery by reducing intraoperative bleeding and shortening the time of surgery. Clinical outcome was better after preoperative embolization, with no occurrence of major complications and mortality. Five AVM's were totally occluded by embolization alone, but of the 5 cases, 1 case was readmitted due to bleeding 2 years after the embolization. It is concluded that combined treatment with preoperative embolization and surgery was helpful in the management of large, high grade AVM's by reducing the complications associated with their surgical removal.

Skull Metastases of Hepatocellular Carcinoma and Presurgical Embolization with Flow-Dependent Micro-Platinum Coil: Case Report

Surgical removal of bone metastasis from hepatocellular carcinoma frequently produces profuse bleeding. To reduce bleeding, we have performed preoperative embolization of tumor feeding artery with flow-dependent micro-platinum coils during superselective angiography in a case of frontal bone metastasis from hepatocellular carcinoma. The tumor was removed easily with minimal bleeding after the embolization, so we report the case with review of the relevant literature.

Successful Management of Large Cerebral Arteriovenous Malformation by Preoperative Embolization and One-stage Operation

The surgery of large cerebral arteriovenous malformation(AVM) may be complicated by the potential for serious brain swelling and hemorrhage during operation and/or postoperative period due to "normal perfusion pressure breadthrough(NPPB)". The authors present two cases of successful management of large AVM which anticipated the development of 'NPPB' using hypotension and preoperative embolization. The one case admitted with intraventricular hemorrhage and intracerebral hematoma due to rupture of large occipital AVM. We managed him with one-stage resection, followed by postoperative hypotension successfully. The another case was interesting. He had the history of intracranial hemorrhage about 13 years ago. We treated him conservatively at that time. He also had the another attack of intracranial hemorrhage in 1979. We performed angiography which revealed large AVM around trigon of left lateral ventricle. He also had another one time of intracranial hemorrhage in 1985. In 1986, We decided to treat him surgically and repeated angiography which showed enlarged AVM compare to size of AVM in previous angiogram of 1979 definitely. We embolized this lesion with Ivalon(R)(polyvinyl alcohol) and confirmed decreased size of AVM. During waiting the surgical resection, another intracranial hemorrhage occurred and recovered without surgical management. In May 1987, we decided to do operation and performed preoperative angiography, which showed reenlarged of previous embolic obliterated AVM. We resected that AVM successfully and discharged him without any aggravation of previous neurological signs. The pathologic findings of resected embolized AVM revealed infiltration of neurtrophils within vessel walls and foreign body material, surrounded by multinucleated foreign body giant cells, epitheloid cells in the vessel lumen. We reviewed the literature and discussed the enlargement of AVM, the treatment of large AVM, especially in point of view about 'NPPB' and pathologic findings of embolized AVM with Ivalon(R)(polyvinyl alcohol).

Peritumoral Bleeding as a Complication in Preoperative Embolization of Meningioma: Case Report

A case of rare complication in preoperative embolization of intracranial meningioma is reported. A 42-year old man who was diagnosed as left parietal convexity meningioma underwent embolization of feeding vessels through the selective angiography. In the process of embolization of middle meningeal artery, after superficial temporal artery occlusion, there was sudden dye leakage around the tumor on the fluoroscopy suggesting the peritumoral bleeding. On the operation we could find the large hematoma around the mass. We are reporting this rare complication with the discussion of the possible etiology.