Preoperative Transarterial Embolization Enhances the Surgical Management of Diffuse Plexiform Neurofibroma: A Case Report

Tanaka, Junji; Kuramochi, Akira; Nishi, Naoko; Yuasa, Masayuki; Heshiki, Atsuko

doi:10.1007/s00270-004-0230-2

Cited by 9 publications

(12 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients should also be observed for postoperative hematoma, because hematomas often cause respiratory problems by compressing the airways. 29 Pre-operative tumor embolization has been reported to decrease hemorrhage from neurofibromas, 27 although it was not used in our 3 patients. If a spinal cord tumor exists in the spinal canal, we recommend tumor excision before correction of the kyphosis to prevent SCI, even if the patient had no neurological deficit.…”

Section: Coexisting Paraspinal and Spinal Cord Tumorsmentioning

confidence: 94%

Surgical correction of severe cervical kyphosis in patients with neurofibromatosis Type 1

Kawabata

Watanabe

Hosogane³

et al. 2013

SPI

View full text Add to dashboard Cite

Severe cervical kyphosis requiring surgical treatment is rare in patients with neurofibromatosis Type 1 (NF1). When it occurs, however, dystrophic changes in the vertebrae make surgical correction and fusion of the deformity extremely difficult. The authors report on 3 cases of severe cervical kyphosis associated with NF1 that were successfully treated with combined anterior and posterior correction and fusion. All patients underwent halo-gravity traction for approximately 1 month prior to surgery to correct the deformity gradually. Posterior correction and fusion were performed with segmental spinal instrumentation consisting of lateral mass screws, lamina screws, pedicle screws, and polyethylene tape for sublaminar wiring. Anterior spinal fusion was performed using a fibula strut to induce solid bone fusion. All patients used a halo vest for postoperative external fixation. Preoperative CT scans showed dystrophic cervical spine changes, and MR images demonstrated extensive neurofibromas outside the cervical spine in all 3 patients. The preoperative kyphotic angles were as follows: Case 1, 140°; Case 2, 81°; and Case 3, 72°; after halo-gravity traction, the kyphosis angles improved to 50°, 55°, and 51°, respectively; and after surgery, they were 50°, 15°, and 27°, respectively. Solid bone union was observed in all patients at the latest follow-up. All three patients experienced postoperative complications consisting of superficial infection, severe pneumonia, and partial dislocation of the distal fibula graft after removing the halo vest, in one patient each. Although dystrophic cervical vertebral changes in these patients with NF1 complicated the correction of severe cervical kyphosis, the use of preoperative halo-gravity traction, a combination of spinal instrumentations, an anterior strut bone graft, and postoperative halo-vest fixation made it possible to correct the kyphosis, maintain the correction, and achieve solid bone fusion.

show abstract

Section: Coexisting Paraspinal and Spinal Cord Tumorsmentioning

confidence: 94%

Surgical correction of severe cervical kyphosis in patients with neurofibromatosis Type 1

Kawabata

Watanabe

Hosogane³

et al. 2013

SPI

View full text Add to dashboard Cite

show abstract

“…It is therefore recommended as the first-choice treatment for hemorrhage and also the rescue treatment for recurrent bleeding (23,24). Preoperative transarterial embolization is also reported to facilitate the surgical management of diffuse plexiform neurofibroma (25). Vascular lesions are much more common in patients with type 1 neurofibromatosis than previously thought.…”

Section: Discussionmentioning

confidence: 96%

Spontaneous Hemorrhage within the Neck of a Neurofibromatosis Type 1 Patient

Hung

Yang

Huang

et al. 2012

The Journal of Emergency Medicine

View full text Add to dashboard Cite

“…The vessels were embolised proximally to reduce flow in the major vascular pedicles at the level of surgical dissection and to reduce skin necrosis associated with a distal embolisation technique. Tanaka et al [20] embolised a plexiform neurofibroma on the arm, but they used particulate embolic agents. We avoided particulates owing to the sheer size of the lesion and to limit skin necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…Pre-operative coil embolisation was used to reduce the blood flow to the tumour and to limit intra-operative blood loss [7,20,21]. The vessels were embolised proximally to reduce flow in the major vascular pedicles at the level of surgical dissection and to reduce skin necrosis associated with a distal embolisation technique.…”

Section: Discussionmentioning

confidence: 99%

Intravascular embolisation and surgical resection of a giant neurofibroma with intratumoural haemorrhage

Jones¹,

Kiatisevi²,

Morris³

et al. 2010

BJR

View full text Add to dashboard Cite

ABSTRACT. The use of pre-operative embolisation has been described for small neurofibromas, but not for giant lesions. Advances in embolisation techniques are extending the indications for this procedure, in particular to assist with operative intervention on a range of lesions. This case report describes a 45-year-old male with a giant neurofibroma who underwent embolisation to stabilise intratumoural haemorrhage and to assist with haemostasis during the subsequent surgical resection. Minimal transfusion was required and the patient has made a good recovery. This case demonstrates that pre-operative embolisation of these large and challenging lesions is technically feasible and appears to be beneficial in reducing perioperative blood loss and morbidity. Neurofibromas are common benign soft-tissue tumours arising within peripheral nerves. Solitary neurofibromas are more common, whereas multiple neurofibromas are often associated with neurofibromatosis type 1 (NF-1) [1]. Plexiform neurofibromas rarely grow to be larger than 5 cm; however, giant neurofibromas can occur and are commonly associated with NF-1. Neurofibromas are difficult to manage surgically as they are extensively infiltrative and highly vascular. Complications of neurofibromas are rare, but include malignant change and potentially life-threatening haemorrhage [2].We report a case of haemorrhage into a giant plexiform neurofibroma of the lower back and buttock causing hypovolaemic shock. This was subsequently managed with intravascular embolisation followed by surgical resection, demonstrating that this technique is technically feasible and should be considered for these lesions. Case reportAn otherwise well 45-year-old Caucasian man presented with bleeding from a solitary large mass over the posterior aspect of his right buttock and lumbar region. Although he initially denied it, he later revealed the mass had been present for over 10 years and had gradually enlarged during this time. Recently, the lesion had increased in size rather rapidly and suffered an overlying skin breakdown. He was bleeding from the surface of the lesion and became hypotensive with some renal impairment, which later recovered. He received a transfusion of 12 units of blood during stabilisation prior to transfer to our centre.Upon arriving at our centre, examination revealed a large, tender, soft mass measuring 70 6 50 6 20 cm extending from the thoracolumbar region to the gluteal fold and overhanging the posterior aspect of his thigh. A large café-au-lait spot covered the lesion (Figure 1). He was haemodynamically stable and the lesion was no longer bleeding from the surface.A CT scan revealed a large soft-tissue mass arising from the subcutaneous tissues of the lower back and extending outside of the available field of view. Loss of fat planes between the mass and the erector spinae muscle was suggestive of possible deep muscular invasion (Figure 2a).MRI was technically difficult and limited by motion artefact; much of the gluteal mass was not included on the field of view...

show abstract

Preoperative Transarterial Embolization Enhances the Surgical Management of Diffuse Plexiform Neurofibroma: A Case Report

Cited by 9 publications

References 3 publications

Surgical correction of severe cervical kyphosis in patients with neurofibromatosis Type 1

Surgical correction of severe cervical kyphosis in patients with neurofibromatosis Type 1

Spontaneous Hemorrhage within the Neck of a Neurofibromatosis Type 1 Patient

Intravascular embolisation and surgical resection of a giant neurofibroma with intratumoural haemorrhage

Contact Info

Product

Resources

About