Safety and efficacy of preoperative embolization of intracranial hemangioblastomas

Chibawanye I. Ene, David Xu, Ryan P. Morton, Samuel Emerson, Michael R. Levitt, Jason Barber, Robert C. Rostomily, Basavaraj V. Ghodke, Danial K. Hallam, Felipe C. Albuquerque, Cameron McDougall, Laligam N. Sekhar, Manuel Ferreira, Louis J. Kim, Steve W. Chang

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)135-140
Number of pages6
JournalOperative Neurosurgery
Volume12
Issue number2
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

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Hemangioblastoma
Safety
Polyvinyl Alcohol
Central Nervous System Neoplasms
Neoplasms
Proxy
Operative Time
Infarction
Blood Vessels
Magnetic Resonance Imaging
Hemorrhage
Morbidity

Keywords

  • Embolization
  • Hemangioblastoma
  • Hemorrhage
  • n-BCA
  • Onyx
  • Tumor

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Ene, C. I., Xu, D., Morton, R. P., Emerson, S., Levitt, M. R., Barber, J., ... Chang, S. W. (2016). Safety and efficacy of preoperative embolization of intracranial hemangioblastomas. Operative Neurosurgery, 12(2), 135-140. https://doi.org/10.1227/NEU.0000000000001014

Safety and efficacy of preoperative embolization of intracranial hemangioblastomas. / 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; Sekhar, Laligam N.; Ferreira, Manuel; Kim, Louis J.; Chang, Steve W.

In: Operative Neurosurgery, Vol. 12, No. 2, 01.06.2016, p. 135-140.

Research output: Contribution to journalArticle

Ene, CI, Xu, D, Morton, RP, Emerson, S, Levitt, MR, Barber, J, Rostomily, RC, Ghodke, BV, Hallam, DK, Albuquerque, FC, McDougall, C, Sekhar, LN, Ferreira, M, Kim, LJ & Chang, SW 2016, 'Safety and efficacy of preoperative embolization of intracranial hemangioblastomas', Operative Neurosurgery, vol. 12, no. 2, pp. 135-140. https://doi.org/10.1227/NEU.0000000000001014
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 ; Sekhar, Laligam N. ; Ferreira, Manuel ; Kim, Louis J. ; Chang, Steve W. / Safety and efficacy of preoperative embolization of intracranial hemangioblastomas. In: Operative Neurosurgery. 2016 ; Vol. 12, No. 2. pp. 135-140.
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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.",
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T1 - Safety and efficacy of preoperative embolization of intracranial hemangioblastomas

AU - Ene, Chibawanye I.

AU - Xu, David

AU - Morton, Ryan P.

AU - Emerson, Samuel

AU - Levitt, Michael R.

AU - Barber, Jason

AU - Rostomily, Robert C.

AU - Ghodke, Basavaraj V.

AU - Hallam, Danial K.

AU - Albuquerque, Felipe C.

AU - McDougall, Cameron

AU - Sekhar, Laligam N.

AU - Ferreira, Manuel

AU - Kim, Louis J.

AU - Chang, Steve W.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - 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.

AB - 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.

KW - Embolization

KW - Hemangioblastoma

KW - Hemorrhage

KW - n-BCA

KW - Onyx

KW - Tumor

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