[Embolization and detached balloon occlusion by the femoral route in craniofacial lesions].
Embolization and detached balloon occlusion by the femoral route were performed in 45 cases: 19 cases of meningiomas, 5 of scalp arteriovenous malformations (AVMs), 4 of dural AVMs, 6 of cerebral AVMs, 8 of facial angiomas and 3 of carotid cavernous sinus fistulas (CCFs); and favorable results were attained. In meningiomas, there is only a short interval between the embolization and the removal of tumor (we usually perform the embolization a couple of days before the removal), and we use Gelfoam as embolus material. We aim at central tumor embolization with small emboli. The embolization reduced bleeding in removing the tumors, simplifying the surgical procedure, and 12 of 19 cases required no blood transfusion. Almost all cases of scalp AVMs, dural AVMs and facial angiomas could most probably be cured only by the embolization without surgery. Gelfoam was the first choice, because it would probably dissolve, and also because it would be relatively safe even if pulmonary embolism might occur as a result of probable passage of its emboli onto the venous side. In recanalized cases, the embolization was performed again with Ivalon, a permanent embolus material. The most important of this procedure is to inject the emboli of the suitable size for each case together with a suitable contrast material at as low a rate as possible under the image intensifier. Embolization by the injection pressure should never be tried, but the emboli be allowed to be carried only on the blood flow to the distal side. And the embolization should be discontinued at the stage when the contrast material has stagnated. CCFs are very good indications for the detached balloon occlusion, while this technic proved to serve for no more than occluding the feeding vessels in cerebral AVMs; in other words, it is indicated in a rather limited range of AVMs. We have encountered no severe complications in any of the cases treated by the embolization and detached balloon occlusion.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000601:surgery*; D001165:Arteriovenous Malformations / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000601:surgery; D002426:Cavernous Sinus; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000379:methods*; D005153:Facial Neoplasms / Q000628:therapy*; D005260:Female; D005263:Femoral Artery; D006391:Hemangioma / Q000628:therapy*; D006801:Humans; D007223:Infant; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery; D008577:Meningeal Neoplasms / Q000628:therapy*; D008579:Meningioma / Q000628:therapy*; D008875:Middle Aged; D012535:Scalp / Q000098:blood supply