Head, neck, and brain tumor embolization guidelines

Department of Neurosurgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ, USA.
Journal of Neurointerventional Surgery (Impact Factor: 2.77). 04/2012; 4(4):251-5. DOI: 10.1136/neurintsurg-2012-010350
Source: PubMed


Management of vascular tumors of the head, neck, and brain is often complex and requires a multidisciplinary approach. Peri-operative embolization of vascular tumors may help to reduce intra-operative bleeding and operative times and have thus become an integral part of the management of these tumors. Advances in catheter and non-catheter based techniques in conjunction with the growing field of neurointerventional surgery is likely to expand the number of peri-operative embolizations performed. The goal of this article is to provide consensus reporting standards and guidelines for embolization treatment of vascular head, neck, and brain tumors.
This article was produced by a writing group comprised of members of the Society of Neurointerventional Surgery. A computerized literature search using the National Library of Medicine database (Pubmed) was conducted for relevant articles published between 1 January 1990 and 31 December 2010. The article summarizes the effectiveness and safety of peri-operative vascular tumor embolization. In addition, this document provides consensus definitions and reporting standards as well as guidelines not intended to represent the standard of care, but rather to provide uniformity in subsequent trials and studies involving embolization of vascular head and neck as well as brain tumors.
Peri-operative embolization of vascular head, neck, and brain tumors is an effective and safe adjuvant to surgical resection. Major complications reported in the literature are rare when these procedures are performed by operators with appropriate training and knowledge of the relevant vascular and surgical anatomy. These standards may help to standardize reporting and publication in future studies.

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Available from: Justin F Fraser, Oct 05, 2015
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    • "Embolization involves closing of the vessel that supplies the tumor by introducing an embolic agent into its lumen. A number of modifications were introduced into the technique during the past years, indications for it were broadened and new, effective embolization materials were invented [4,5]. Selection of proper material depends on the character of embolization, predicted artery closing time as well as location and vessel diameter. "
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    ABSTRACT: A lot has changed in terms of intervention technique, indications and embolic agents since Duggan introduced embolization to management of postraumatic epistaxis in 1970. Embolization is used in treatment of spontaneous and traumatic epistaxis, palliative tumors and vascular defects, as well as vascularized tumors and juvenile nasopharyngeal angiofibromas. The possibility of simultaneous visualization of pathology and implementation of therapy is one of its greatest advantages. Authors analyzed the efficacy of selective embolization treatment of haemorrhage in advanced head and neck tumors. Seventy-six patients with such tumors treated at the Department of Otolaryngology in Bialystok between1999 and 2011 were examined. Embolization of bleeding vessel within the tumor was effective (hemorrhage was stopped) in 65 patients (86%). Although the method is highly efficient, it is still associated with complications. Fourteen patients suffered from headaches that lasted for several days and six from face edema. Rebleeding was rare. Unfortunately, there was one case of hemiparesis. We conclude that superselective endovascular treatment deserves to be considered alongside standard options for the palliative or preoperative management of acute hemorrhage from advanced head and neck cancers.
    Polish Journal of Radiology 10/2012; 77(4):17-21.
  • Journal of Neurointerventional Surgery 10/2012; 5(6). DOI:10.1136/neurintsurg-2012-010538 · 2.77 Impact Factor
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    ABSTRACT: Background/purpose: Preoperative embolization of head, neck, and spinal tumors is frequently used to control tumor bleeding, reduce operative time, and achieve better resection. Numerous embolic materials have been used. The use of the liquid embolic agent Onyx is rapidly increasing but current experience is limited to small case series. Our purpose was to evaluate the indications, techniques, angiographic devascularization, blood loss, outcome, and general efficacy of preoperative tumor embolization with Onyx in a large series. Methods: Retrospective analysis of 100 consecutive cases of head, neck, and spinal tumors embolized with Onyx and prospective follow-up. Results: 100 patients (63 women, 37 men) were included. Tumors included 39 meningiomas, 23 metastases, 16 parangliomas, five juvenile nasal angiofibromas, five giant cell bone tumors, three Ewing's sarcomas, three hemangiomas, three hemangioblastomas, two multiple myelomas, and one osteoblastoma. In all patients, angiographic analysis of the feeding arteries and branches was performed and all embolizations were completed in a single session. Additional materials were used in 28 patients. No mortality or major complications were observed. Minor complications were seen in 11 patients. 85 patients underwent surgery; 79 within the next 48 h and six of them 4-188 days after embolization. Conclusions: Embolization of intracranial, head, neck, and spinal tumors with Onyx is effective and safe by a transarterial route or by direct puncture. Onyx penetrates well into the tumor capillary with less arterial catheterization. Studies are necessary to establish long term utility in adjunct or palliative tumor embolization.
    Journal of Neurointerventional Surgery 12/2012; 6(1). DOI:10.1136/neurintsurg-2012-010542 · 2.77 Impact Factor
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