Pre-operative Embolization of Intracranial and Extracranial Tumors: A Review of 37 Cases
Prasert Iampreechakul MD*, Wuttipong Tirakotai MD*, Punjama Lertbutsayanukul MD**, Somkiet Siriwimonmas MD***, Anusak Liengudom MD*
Affiliation : * Department of Neurological Surgery, Prasat Neurological Institute, Bangkok, Thailand ** Department of Neuroradiology, Prasat Neurological Institute, Bangkok, Thailand *** Department of Radiology, Bumrungrad International Hospital, Bangkok, Thailand
Objective : 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.
Material and Method: 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.
Results : 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
embolization was seven days (ranged 1-171 days). There was statistically significant difference between grading of angiographic
devascularization and estimated blood loss (p = 0.009, Kruskal-Wallis test). Two patients (5.4%) had embolization-related
complications, including hemorrhage during sub-selective catheterization and postoperative scalp necrosis.
Conclusion : 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.
Keywords : Pre-operative embolization, Brain tumor, Cranial tumor, Meningioma, Hemangiopericytoma, Hemangioblastoma, Paraganglioma, Intra-axial tumor
