title: 3D-guided direct puncture therapeutic embolization of intracranial tumors.
abstract: BACKGROUND
  Direct punctures of intracranial tumors have rarely been described in the literature.
  
  
  OBJECTIVE
  To assess the feasibility, safety, efficacy, and advantages of using 3D DSA-guided direct puncture rather than the traditional transarterial route to preoperatively devascularize intracranial lesions in particular clinical situations, paying special attention to any correlation with surgical observations; we present the largest series to date.
  
  
  METHODS
  Between July 2015 and July 2016, data from all presurgical embolizations performed in our institution were prospectively collected. Information on tumor type, location, size, eventual bone erosion, complications, devascularization percentage, and estimated blood loss was analyzed.
  
  
  RESULTS
  Tumors of four patients (two meningioma, two endolymphatic sac tumor) were embolized using direct puncture. 3D XperGuide planning software was used in all procedures. Embolization was feasible in all cases. In one case, a small craniotomy was specifically performed to allow needle positioning. In all cases n-butyl cyanoacrylate was used. No ischemic or hemorrhagic complications related to embolization occurred. Complete or near complete devascularization was obtained in all cases. In one case, surgery was not performed and the patient was monitored. Resection was complete without significant blood loss in two cases, and resection was incomplete but satisfactory in one case.
  
  
  CONCLUSIONS
  In selected cases, 3D-guided direct puncture of intracranial tumors appears safe, feasible, and efficient for preoperative embolization.
authors.affiliation: Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France.
authors.forename: Jildaz
authors.identifier: http://orcid.org/0000-0002-0029-1835
authors.initials: J
authors.lastname: Caroff
authors.affiliation: Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France.
authors.forename: Nidhal
authors.initials: N
authors.lastname: Benachour
authors.affiliation: Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France.
authors.forename: Léon
authors.initials: L
authors.lastname: Ikka
authors.affiliation: Department of Otorhinolaryngology, Le Kremlin-Bicêtre, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Nevoux
authors.affiliation: Department of Neurosurgery, Bicêtre Hospital, Le Kremlin-Bicêtre, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Parker
authors.affiliation: Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France.|Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata, Rome, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Da Ros
authors.affiliation: Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France.|Department of Neurosurgery, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.
authors.forename: Cristian
authors.initials: C
authors.lastname: Mihalea
authors.affiliation: Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France.|Department of Bioimaging and Radiological Sciences, Policlinico "A. Gemelli". Rome, Italy.
authors.forename: Marta
authors.identifier: http://orcid.org/0000-0002-3911-3278
authors.initials: M
authors.lastname: Iacobucci
authors.affiliation: Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France.|Faculté de Médecine, Université Paris Sud, Le Kremlin-Bicêtre, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Moret
authors.affiliation: Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France.|Faculté de Médecine, Université Paris Sud, Le Kremlin-Bicêtre, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Spelle
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D003399:Craniotomy / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011677:Punctures / Q000379:methods*
keywords: Embolic; Intervention; Liquid Embolic Material; Malignant; Tumor