Article
Embolisation prior to haemangioblastoma surgery – in which cases is it advisable?
Embolisation vor der Resektion von Hämangioblastomen – in welchen Fällen ist dies ratsam?
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Authors
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Jan-Helge Klingler
- Medical Center, University of Freiburg, Department of Neurosurgery, Freiburg, Deutschland
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Samer Elsheikh
- Medical Center, University of Freiburg, Department of Neuroradiology, Freiburg, Deutschland
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Bianca-Ioana Blaß
- Medical Center, University of Freiburg, Department of Neurosurgery, Freiburg, Deutschland
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Romina Hohenhaus
- Medical Center, University of Freiburg, Department of Neurosurgery, Freiburg, Deutschland
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Jürgen Beck
- Medical Center, University of Freiburg, Department of Neurosurgery, Freiburg, Deutschland
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Christine Steiert
- Medical Center, University of Freiburg, Department of Neurosurgery, Freiburg, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Hemangioblastomas are highly vascularized tumors and can be associated with von Hippel-Lindau (VHL) disease. Preoperative embolization has been proposed to occlude tumor-feeding vessels and thus reduce the perfusion of the tumor. However, preoperative embolization is not an established standard, and the available evidence is mainly based on uncontrolled retrospective small case series. In this context, the safety and efficacy of preoperative embolization for central nervous system (CNS) hemangioblastomas are not well characterized. We share the experience of our interdisciplinary VHL center with preoperative embolization and subsequent microsurgical removal of CNS hemangioblastomas.
Methods: We reviewed all resected CNS hemangioblastomas over a period of six years (2014 - 2020) in our VHL center. We examined radiographic and clinical criteria such as imaging tumor characteristics, extent of devascularization and tumor resection, complications, intraoperative blood loss, transfusion requirements, and the neurological status according to the modified Rankin Scale and modified McCormick Scale.
Results: In total, 131 patients had surgery for removal of up to six hemangioblastomas. Preoperative embolization was performed for 8 spinal and 6 intracranial hemangioblastomas in 14 patients (10.7 %). The volume of tumors selected for embolization was 7.4 ± 8.4 cm3; intraoperative blood loss was 605 ± 485 ml. Two of these patients (14.3 %) experienced embolization-related complications, including femoral artery dissection and permanent cranial nerve dysfunction. Subsequent hemangioblastoma surgery did not lead to permanent neurological deficits.
Conclusion: Preoperative embolization should not be considered standard of care for CNS hemangioblastomas, as it harbors a potential for neurological deterioration. Smaller CNS hemangioblastomas can usually be safely removed without the need for preoperative embolization. For larger hemangioblastomas, however, preoperative embolization may be advisable. This additional intervention should be carefully indicated on a personalized basis and should be reserved for specialized interdisciplinary centers.
