PREOPERATIVE ENDOVASCULAR EMBOLIZATION OF CRANIOSPINAL HEMANGIOBLASTOMAS

PURPOSE: To determine whether hemangioblastomas, highly vascular tumor s requiring surgery that is potentially complicated by excessive bleed ing, can be embolized safely by using interventional techniques that f urnish a more avascular surgical field. METHODS: Nine hemangioblastoma s involving either the cerebellum or the spinal cord were embolized pr eoperatively. In each case the feeding artery was selectively catheter ized with a microcatheter and the hypervascular tumor nidus was devasc ularized with polyvinyl alcohol particles. RESULTS: Two patients who h ad undergone recent attempts at surgical resection at another institut ion had repeat surgery after endovascular embolization rendered the tu mor nidus avascular, At surgery, the tumor was completely removed in o ne case and markedly debulked in the other. In all nine cases, blood l oss after embolization was reported to be less than expected by experi enced surgeons, In addition, manipulation and removal of the tumor was reported to be subjectively easier in these embolized tumors. The emb olization procedure caused no permanent complications; however, one pa tient with a posterior fossa hemangioblastoma and hydrocephalus worsen ed clinically within 12 hours of embolization, This event was thought to be caused by obstructive hydrocephalus resulting from tumor swellin g. Emergency craniotomy, ventricular decompression, and surgical resec tion of the tumor produced complete resolution of the signs and sympto ms. CONCLUSIONS: Our results indicate that preoperative embolization o f hemangioblastomas is a safe procedure that is useful in aiding surgi cal resection of these highly vascular tumors.