Intratumoral ethyl alcohol injection for devascularization of hypervascular intracranial tumors

Abstract

Pre-operative endovascular embolization of tumor feeders with various embolic agents is a widely accepted method (3,6,18). The purpose of embolization is not only to occlude the vascular supply to the tumor, to achieve tumor necrosis and to decrease intraoperative blood loss, but also to maintain better visualization of surgical fields, which decreases the risk of adjacent tissue destruction and tumor recurrence (3). However, cases requiring emergent surgical intervention and tumors with feeders that also supply important normal anatomical structures may limit utilization of preoperative embolization (6,18). Additionally, there may be some cases that undergo surgery in which massive bleeding during surgery is not expected. Consequently, reducing intratumoral blood flow or at least decreasing it to a more acceptable level █ INTRODUCTION A safe and effective resection of intracranial tumors depends on meticulous homeostasis (11,18,27). Brain tumors with rich vascular structures and deeply seated feeding arteries running at the opposite site of the surgical field may cause dangerous bleeding problems, which are likely to result in higher mortality and morbidity. The control of bleeding is usually difficult and the surgical duration is longer (3,6,12). These unexpected and abrupt bleedings may not sometimes allow total excision of the tumor. Currently, the overall consensus within the field of neurosurgery is that preoperative tumor embolization is beneficial for reducing intraoperative blood loss in patients with vascular tumors (6,12).AIM: Hypervascular intracranial tumors may cause serious bleeding in surgery. Though pre-operative endovascular embolization of tumor is a widely accepted method, sometimes despite embolization, an effective and safer intraoperative hemostatic technique is needed to prevent or at least decrease the massive bleeding from the tumors. The aim of this study was to investigate the effect of the ethyl alcohol (EA) injection in hypervascular tumors and find out whether it is likely to be an alternative method to prevent massive bleeding from tumor. MATERIAL and METhODS:Fifty-five cases that had hypervascular intracranial tumor and underwent EA injections into their tumors were included in the study. A small amount (0.1-0.2 ml) of EA was used in every injection. Total EA amount differed from 1.2 to 18 ml for each patient. RESULTS:Most of the tumors were removed with less bleeding, because bleedings stopped or decreased during resection after EA injections. No serious complication that might be related to EA was observed. CONCLUSION:EA injection into the tumor is an easy, cheap and less invasive method to obtain effective and safe tumor devascularization. It may be an alternative method for tumor devascularization when preoperative embolization cannot be performed due to any reason or severe bleeding despite embolization.

Ethanol and NaCl-Induced Gold Nanoparticle Aggregation Toxicity toward DNA Investigated with a DNA/GCE Biosensor

“…Ethanol is often an active ingredient in oral, parenteral, and topical drugs [ 17 ]. Ethanol has been used in a variety of cases for injection therapy of trigeminal neuralgia [ 18 ], tumor therapy [ 19 , 20 , 21 , 22 ], and as a form of pain relief [ 23 , 24 ]. Ethanol is absorbed by passive alcoholization by hand rubbing [ 25 ].…”

Concern and usefulness of intratumoral injection of ethyl alcohol for devsacularization of intracranial tumors

“…The authors concluded that intratumoral ethyl alcohol injection is an easy, cheap and less invasive way to obtain effective and safe reduction of vascularity and it may constitute an alternative method in the event of intra-operative severe bleeding despite embolization. However, no serious complication was observed in the study (3).…”