Staged surgical treatment of a hypervascular cerebellar hemangioblastoma and saccular superior cerebellar artery aneurysm using preoperative embolization with a low viscosity non-adhesive liquid embolic agent

Sirko, Andriy; Halkin, Mykyta; Cherednychenko, Yu.V.; Perepelytsia, V.P.

doi:10.1016/j.inat.2021.101232

Cited by 2 publications

(2 citation statements)

References 15 publications

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“…The first reports of preoperative embolization refer to the use of polyvinyl alcohol particles between 150 to 250 um, with subsequent surgery within the 1 st -week post embolization,[ 18 ] n-butyl cyanoacrylate can also be used but currently other types of embolizing materials have better results, among them are the ethylene vinyl alcohol copolymer[ 5 ] and the precipitating hydrophobic injectable liquid. [ 15 ] In both cases, we used ethylene vinyl alcohol copolymer with good outcomes.…”

Section: Discussionmentioning

confidence: 99%

Multimodal management of giant solid hemangioblastomas in two patients with preoperative embolization

Vargas-Urbina,

Crisanto-Silva,

Vásquez-Perez

et al. 2024

Surgical Neurology International

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Background: Hemangioblastomas are benign vascular neoplasms, World Health Organization grade I, with the most frequent location in the cerebellum. Complete microsurgical resection can be a challenge due to excessive bleeding, which is why preoperative embolization takes importance. Case Description: Two clinical cases are presented, a 25-year-old woman and a 75-year-old man, who presented with intracranial hypertension symptoms due to obstructive hydrocephalus; a ventriculoperitoneal shunt was placed in both cases; in addition, they presented with cerebellar signs. Both underwent embolization with ethylene vinyl alcohol copolymer, with blood flow reduction. After that, they underwent microsurgical resection within the 1st-week post embolization, obtaining, in both cases, gross total resection without hemodynamic complications, with clinical improvement and good surgical outcome. It is worth mentioning that surgical management is the gold standard that allows a suitable surgical approach, like in our patients, for which a lateral suboccipital craniotomy was performed. Conclusion: Solid hemangioblastomas are less frequent than their cystic counterparts. The treatment is the surgical resection, which is a challenge and always has to be considered as an arteriovenous malformation in the surgical planning, including preoperative embolization to reduce perioperative morbidity and mortality and get good outcomes.

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Section: Discussionmentioning

confidence: 99%

Multimodal management of giant solid hemangioblastomas in two patients with preoperative embolization

Vargas-Urbina,

Crisanto-Silva,

Vásquez-Perez

et al. 2024

Surgical Neurology International

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“… 1 Precursor lesions are frequently localized to dorsal roots of the spinal column and the cerebellum molecular layer, lending to tumors in the spinal cord, brainstem, and infratentorial cerebellum. 2 , 3 HBs are highly vascular, given their ability to initiate reactive angiogenesis, establishing abundant and dilated blood vessels. 2 Many cerebellar lesions consist of a solid tumor with an associated heterogeneous cystic mass and peritumoral edema that can damage or compress surrounding tissues.…”

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confidence: 99%

Preoperative embolization and microsurgical resection of a cerebellar hemangioblastoma: embolization goals and technical nuances of the approaches. Illustrative case

Reecher,

Hussain,

Treffy

et al. 2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND Resection remains the optimal treatment for hemangioblastomas, highly vascular tumors commonly located in the cerebellum or spinal cord. Preoperative embolization can be used with caution to reduce intraoperative blood loss and promote gross-total resection while reducing neurological morbidity. OBSERVATIONS The authors report a case of a 44-year-old male who presented with worsening dizziness, gait imbalance, and diplopia. Imaging revealed a large vascular cerebellar mass with brainstem compression and hydrocephalus, concerning for hemangioblastoma. The patient underwent preoperative embolization of the main arterial supply from the right superior cerebellar artery, which devascularized the tumor and reduced the early venous shunting, followed by gross-total resection of the tumor. Preoperative embolization helped to facilitate safe microsurgical resection because this main arterial supply was deep to the planned surgical approach, and the Onyx cast served as a landmark of the dorsal midbrain and remaining arterial supply. This resulted in minimal intraoperative blood loss. At 2-year follow-up, the patient’s diplopia and vertigo had resolved, and his gait continues to improve. LESSONS Despite controversy regarding the use of preoperative embolization for hemangioblastoma resection, the authors emphasize its safety and utility during resection of a large cerebellar hemangioblastoma. Onyx embolization provided benefit in both reducing the tumor blood supply and serving as intraoperative visual guidance.

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Staged surgical treatment of a hypervascular cerebellar hemangioblastoma and saccular superior cerebellar artery aneurysm using preoperative embolization with a low viscosity non-adhesive liquid embolic agent

Cited by 2 publications

References 15 publications

Multimodal management of giant solid hemangioblastomas in two patients with preoperative embolization

Multimodal management of giant solid hemangioblastomas in two patients with preoperative embolization

Preoperative embolization and microsurgical resection of a cerebellar hemangioblastoma: embolization goals and technical nuances of the approaches. Illustrative case

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