Safety and Efficacy of Preoperative Embolization of Intracranial Hemangioblastomas
Department
neurosurgery
Document Type
Article
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.
Publication Date
2016
Publication Title
Operative Neurosurgery
ISSN
2332-4252
Volume
12
Issue
2
First Page
135
Last Page
140
Digital Object Identifier (DOI)
10.1227/NEU.0000000000001014
Recommended Citation
Ene, Chibawanye I.; Xu, David; Morton, Ryan P.; Emerson, Samuel; Levitt, Michael R.; Barber, Jason; Rostomily, Robert C.; Ghodke, Basavaraj V.; Hallam, Danial K.; Albuquerque, Felipe C.; Mcdougall, Cameron G.; Sekhar, Laligam N.; Ferreira, Manuel; Kim, Louis J.; and Chang, Steve W., "Safety and Efficacy of Preoperative Embolization of Intracranial Hemangioblastomas" (2016). Neurosurgery. 370.
https://scholar.barrowneuro.org/neurosurgery/370