Pre-operative embolisation of internal carotid artery branches and pial vessels in hypervascular brain tumours.
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.
Yoon
Y S
YS
Department of Neurosurgery, Yonsei Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
Ahn
J Y
JY
Chang
J H
JH
Cho
J H
JH
Suh
S H
SH
Lee
B H
BH
Lee
K S
KS
D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001932:Brain Neoplasms / Q000098:blood supply* / Q000175:diagnosis / Q000556:secondary / Q000628:therapy*; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000556:secondary / Q000628:therapy; D002343:Carotid Artery, Internal; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000098:blood supply / Q000628:therapy; D008579:Meningioma / Q000098:blood supply / Q000628:therapy; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010841:Pia Mater / Q000098:blood supply*; D011300:Preoperative Care