title: Preoperative endovascular embolization for hemangioblastoma in the posterior fossa.
abstract: Intracranial hemangioblastomas (HBs) are hypervascular neoplasms mainly located in the posterior fossa of the central nervous system. Preoperative embolization of the feeding arteries is one proposal for reduction of intraoperative hemorrhage, although indications for the procedures should be evaluated carefully due to the potential complications. This retrospective study investigated clinical outcomes and complications of 15 patients with HBs in the posterior fossa to evaluate the safety and effectiveness of endovascular procedures as well as angiographical procedures. Surgical excision without presurgical embolization was performed in 8 cases, and excision with presurgical embolization was performed in 7 cases, using Guglielmi detachable coils with or without polyvinyl alcohol (GDC ± PVA) in 4 cases and only n-butyl 2-cyanoacrylate (NBCA) in 3 cases. The embolization was applied for selected cases in which feeding arteries were located in a deep site and hard to coagulate surgically. Partial embolization was achieved in 5 cases, and all feeders were successfully embolized in 2 cases. Total removal was achieved in 12 cases, and subtotal/partial removal was achieved in 3 cases. Subarachnoid hemorrhage with intratumoral hemorrhage occurred in 1 case during the angiographic procedure and in 1 case during the embolization procedures. The mean volume of intraoperative blood loss was clearly less in the NBCA group than in the GDC ± PVA group. HBs are mainly located in the posterior cranial fossa, so the risk of severe clinical complication may be high if vascular problems occur. In our series, presurgical embolization using NBCA made tumor removal safe and reduced bleeding volume in posterior fossa HBs.
authors.affiliation: Department of Neurosurgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Sakamoto
authors.forename: Eiichi
authors.initials: E
authors.lastname: Ishikawa
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Nakai
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Akutsu
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Kei
authors.initials: K
authors.lastname: Nakai
authors.forename: Masanari
authors.initials: M
authors.lastname: Shiigai
authors.forename: Hideo
authors.initials: H
authors.lastname: Tsurushima
authors.forename: Tomonori
authors.initials: T
authors.lastname: Isobe
authors.forename: Shingo
authors.initials: S
authors.lastname: Takano
authors.forename: Koji
authors.initials: K
authors.lastname: Tsuboi
authors.forename: Akira
authors.initials: A
authors.lastname: Matsumura
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical / Q000503:physiopathology; D001925:Brain Damage, Chronic / Q000209:etiology; D002528:Cerebellar Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D002530:Cerebellopontine Angle / Q000000981:diagnostic imaging / Q000601:surgery; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000209:etiology; D002648:Child; D003131:Combined Modality Therapy; D003388:Cranial Fossa, Posterior / Q000000981:diagnostic imaging / Q000601:surgery; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000008:administration & dosage; D005260:Female; D018325:Hemangioblastoma / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
chemical_list: D004659:Enbucrilate