title: Hybrid Surgery Management of Giant Hypervascular Tumors: Intraoperative Endovascular Embolization with Microsurgical Resection.
abstract: BACKGROUND
  Giant hypervascular intracranial tumors represent a formidable challenge because their size limits surgical control of the blood supply and debulking poses the risk of critical blood loss. Embolization facilitates resection but carries the risk of life-threatening tumor infarction, hemorrhage, or swelling if performed preoperatively. Endovascular intraoperative embolization avoids the fatal risk and allows the surgeon to attend instantly if any complication occurs.
  
  
  RESULTS
  We report 2 cases in which combining intraoperative embolization with microsurgical resection in the hybrid operating room was used to safely and successfully remove giant hypervascular tumors.
  
  
  CONCLUSIONS
  Intraoperative embolization facilitates the safe resection of giant hypervascular tumors and mitigates the consequences of potential tumor infarction, hemorrhage, or swelling from embolization. These cases exemplify the benefits of combining expertise in endovascular and microsurgical techniques with the capabilities of modern hybrid operating rooms allowing for their simultaneous application.
authors.affiliation: Department of Neurosurgery, Brigham and Women Hospital, Harvard School of Medicine, Boston, Massachusetts, USA; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA. Electronic address: rami.almefty@bnaneuro.net.
authors.forename: Rami O
authors.initials: RO
authors.lastname: Almefty
authors.affiliation: Department of Neurosurgery, Brigham and Women Hospital, Harvard School of Medicine, Boston, Massachusetts, USA.
authors.forename: Nirav J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: Department of Neurosurgery, Brigham and Women Hospital, Harvard School of Medicine, Boston, Massachusetts, USA.
authors.forename: Alfred P
authors.initials: AP
authors.lastname: See
authors.affiliation: Department of Neurosurgery, Brigham and Women Hospital, Harvard School of Medicine, Boston, Massachusetts, USA.
authors.forename: Ian F
authors.initials: IF
authors.lastname: Dunn
authors.affiliation: Department of Neurosurgery, Brigham and Women Hospital, Harvard School of Medicine, Boston, Massachusetts, USA.
authors.forename: Ossama
authors.initials: O
authors.lastname: Al-Mefty
authors.affiliation: Department of Neurosurgery, Brigham and Women Hospital, Harvard School of Medicine, Boston, Massachusetts, USA.
authors.forename: Mohammed Ali
authors.initials: MA
authors.lastname: Aziz-Sultan
mesh_terms: D000328:Adult; D002551:Cerebral Ventricle Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D000072226:Computed Tomography Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005682:Gadolinium / Q000378:metabolism; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D055815:Young Adult
chemical_list: D005682:Gadolinium
keywords: Embolization; Endovascular; Hybrid; Meningioma; Onyx; Skull base; Solitary fibrous tumor