title: Role of preoperative embolization of intramedullary hemangioblastoma.
abstract: OBJECTIVE
  Hemangiobastomas (HB) are rare lesions accounting for 1 to 5% of all spinal cord tumors. Due to their hypervascular nature, an angiography may be proposed preoperatively in order to identify tumoral vascular anatomy. Preoperative embolization may be indicated to reduce intraoperative bleeding, thus facilitating tumor resection and minimizing surgical risk. The aim of this paper is to report our experience of preoperative embolization in intramedullary hemangioblastomas.
  
  
  METHODS
  We performed a retrospective analysis of all patients operated on for intramedullary hemangioblastomas between 1995 and 2014 who had undergone embolization before surgery.
  
  
  RESULTS
  Seven patients were analyzed: there were 6 females and 1 male, mean age 43years, 6 patients had Von Hippel-Lindau disease. Four tumors were located in the cervical spine and three in the dorsal spine. The average maximum sagittal diameter was 19mm (range 8-32mm), while the average maximum axial diameter was 11.5mm (range 6-21mm). The embolic agent used was Histoacryl (NBCA). Endovascular embolization was routinely performed the day before surgery. One patient experienced a major preoperative complication with a vertebrobasilar infarctus with consequent unilateral cerebellar syndrome and gait instability. Minor extravasation of embolic agent was observed in two cases. In one of these two cases, there was also the penetration of the embolic agent in the tumor; the resection was impossible due to the hard consistency of the tumor. In the other 6 patients, the resection was total. Six patients had identical preoperative and postoperative McCormick score and one patient shifted to a better score at follow-up.
  
  
  CONCLUSIONS
  Preoperative endovascular embolization is an effective adjunct treatment. It is useful in reducing the surgical bleeding and thus the operative risks. The procedure is not always safe and complications could occur. We recommend preoperative embolization in selected cases.
authors.affiliation: Service de neuroradiologie interventionnelle, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, 78, rue du General-Leclerc, 94275 Kremlin-Bicêtre cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Saliou
authors.affiliation: Service de neurochirurgie, AP-HP, hôpital Bicêtre, Le Kremlin-Bicêtre, 78, rue du General-Leclerc, 94275 Kremlin-Bicêtre cedex, France. Electronic address: lore1985nch@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Giammattei
authors.affiliation: Service de neuroradiologie interventionnelle, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, 78, rue du General-Leclerc, 94275 Kremlin-Bicêtre cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Ozanne
authors.affiliation: Service de neuroradiologie interventionnelle, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, 78, rue du General-Leclerc, 94275 Kremlin-Bicêtre cedex, France; Service de neurochirurgie, AP-HP, hôpital Bicêtre, Le Kremlin-Bicêtre, 78, rue du General-Leclerc, 94275 Kremlin-Bicêtre cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Messerer
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D004621:Embolization, Therapeutic; D005260:Female; D018325:Hemangioblastoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006623:von Hippel-Lindau Disease / Q000209:etiology
keywords: Embolization; Hemangioblastomas; Spinal cord tumor