Preoperative Endovascular Embolization for Hemangioblastoma in the Posterior Fossa

Abstract

Intracranial hemangioblastomas (HBs) are hypervascular neoplasms mainly located in the posterior fossa of the central nervous system. Preoperative embolization of the feeding arteries is one proposal for reduction of intraoperative hemorrhage, although indications for the procedures should be evaluated carefully due to the potential complications. This retrospective study investigated clinical outcomes and complications of 15 patients with HBs in the posterior fossa to evaluate the safety and effectiveness of endovascular procedures as well as angiographical procedures. Surgical excision without presurgical embolization was performed in 8 cases, and excision with presurgical embolization was performed in 7 cases, using Guglielmi detachable coils with or without polyvinyl alcohol (GDC ± PVA) in 4 cases and only n-butyl 2-cyanoacrylate (NBCA) in 3 cases. The embolization was applied for selected cases in which feeding arteries were located in a deep site and hard to coagulate surgically. Partial embolization was achieved in 5 cases, and all feeders were successfully embolized in 2 cases. Total removal was achieved in 12 cases, and subtotal/partial removal was achieved in 3 cases. Subarachnoid hemorrhage with intratumoral hemorrhage occurred in 1 case during the angiographic procedure and in 1 case during the embolization procedures. The mean volume of intraoperative blood loss was clearly less in the NBCA group than in the GDC ± PVA group. HBs are mainly located in the posterior cranial fossa, so the risk of severe clinical complication may be high if vascular problems occur. In our series, presurgical embolization using NBCA made tumor removal safe and reduced bleeding volume in posterior fossa HBs.

Treatment Strategies for Cerebellar Hemangioblastomas: Simple or Further Studies?

“…Cornelius et al (3) reported their experience and concluded that particulate embolization is ineffective for treating cerebellar hemangioblastomas because of high risk of complications. Sakamoto et al (10) showed the mean volume of intraoperative blood loss in resection for hemangioblastomas was clearly less in the N-butyl cyanoacrylate group than in the Guglielmi detachable coils with or without polyvinyl alcohol group. Murai et al (8) also reported the effectiveness of preoperative embolization with N-butyl cyanoacrylate.…”

Clinical Effectiveness of Preoperative Embolization for Cerebellar Hemangioblastoma

“…With the application of microcatheter, microguidewire and other new materials as well as the development of high-resolution angiography and three-dimensional rotational revascularization techniques, preoperative embolization of CHB is becoming popular (Horvathy et al, 2011;Sakamoto et al, 2012). Currently, the most commonly used embolic materials for CHB embolization were physical embolic material (such as balloon and coils), PVA particles and liquid embolic agents (such as ONYX, NBCA).…”

Norovasküler Patolojilerde Temel Embolizasyon Yontemleri ve Malzemeler

“…Küçük partiküller daha distale giderek kapiller yatağı tıkar ve daha etkin embolizasyon sağlar. Ancak distale migrasyon, fizyolojik anastomozlar ile intrakraniyal dolaşıma geçme, kraniyal sinir paralizileri, akciğer embolileri gibi riskler için dikkatli olunmalıdır [6,7].…”