Pre-operative embolisation of internal carotid artery branches and pial vessels in hypervascular brain tumours

Acta Neurochir (Wien). 2008 May;150(5):447-52; discussion 452. doi: 10.1007/s00701-008-1513-1. Epub 2008 Feb 19.

Abstract

Background: Pre-operative embolisation is an effective method used to reduce intra-operative bleeding and operative difficulty in hypervascular brain tumour surgery. However, embolisation of the internal carotid artery (ICA) and pial tumour feeding branches has certain limitations.

Methods: From March 2000 to November 2006, 8 patients underwent superselective embolisation for hypervascular brain tumour. Seven tumours were extra-axial (6 meningiomas, 1 solitary fibrous tumour) and 1 was intra-axial (metastatic hepatocellular carcinoma).

Results: In all patients, feeding vessels from ICA branches or pial arteries were successfully embolised using superselective microcatheterisation. A provocative test was applied in 4 patients who had tumours adjacent to the motor cortex. Angiographic devascularisation was slight to extensive. Mean devascularisation on post-embolisation MRI ranged from 40 to 80% (mean 63.8%). One patient (12.5%) suffered an embolisation-related complication (loss of choroidal brush), but was not clinically worse because of the pre-existing blindness.

Conclusions: Superselective embolisation of ICA branches or pial vessels should be performed if several conditions are met, especially angiographic findings, pre-existing neurologic deficits, provocative test, and technical feasibility. If the ICA embolisation for hypervascular tumour is successfully achieved, the bleeding loss and operative risk can be reduced.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Blood Loss, Surgical / prevention & control
  • Brain Neoplasms / blood supply*
  • Brain Neoplasms / diagnosis
  • Brain Neoplasms / secondary
  • Brain Neoplasms / therapy*
  • Carcinoma, Hepatocellular / blood supply
  • Carcinoma, Hepatocellular / secondary
  • Carcinoma, Hepatocellular / therapy
  • Carotid Artery, Internal*
  • Cerebral Angiography
  • Embolization, Therapeutic* / adverse effects
  • Female
  • Humans
  • Liver Neoplasms / pathology
  • Magnetic Resonance Imaging
  • Male
  • Meningeal Neoplasms / blood supply
  • Meningeal Neoplasms / therapy
  • Meningioma / blood supply
  • Meningioma / therapy
  • Middle Aged
  • Neurosurgical Procedures*
  • Pia Mater / blood supply*
  • Preoperative Care*