Presurgical embolization of tumors of the brain, head and neck, and spinal cord

Diogo C Haussen MD (Dr. Haussen of University of Miami Miller School of Medicine - Jackson Memorial Hospital has no relevant financial relationships to disclose.)
Brandon G Gaynor MD (Dr. Gaynor of University of Miami Miller School of Medicine - Jackson Memorial Hospital has no relevant financial relationships to disclose.)
Dileep R Yavagal MD (Dr. Yavagal of University of Miami Miller School of Medicine received consultation fees from Stryker, Aldagen/Cytomedix, and Covidien/EV3.)
Edward J Dropcho MD, editor. (Dr. Dropcho of Indiana University Medical Center has no relevant financial relationships to disclose.)
Originally released September 24, 2012; last updated May 31, 2014; expires May 31, 2017

Overview

Preoperative embolization of vascular tumors of the head, neck, and spine is considered an important adjunct to the surgical treatment of these lesions, primarily by minimizing the operative blood loss. In this article, the authors outline the fundamentals of preoperative embolization for highly vascularized tumors of head, neck, and spine. The authors discuss the indications, anatomical and physiological considerations, and illustrate technical details concerning the various embolic agents used to treat these complex lesions.

Key points

 

• Preoperative embolization is used for select cases of highly vascularized head, neck, and spinal tumors in order to minimize blood loss during surgery.

 

• The primary route for tumor embolization is transarterial; direct percutaneous puncture is an alternative for select cases.

 

• Commonly used materials available for embolization include n-butyl cyanoacrylate, ethylene vinyl alcohol, polyvinyl alcohol, and detachable coils.

 

• Preoperative embolization can be effective in reducing intraoperative blood loss by devascularizing hypervascular head, neck, and spinal tumors.

Historical note and terminology

The term “embole” historically has had multiple connotations (Schiller 1970). In 1849, Virchow coined the use of “embolus” for the dislodgment of fragments of venous clots into the circulation generating arterial obstruction (Schiller 1970). Currently, the word “embolus” represents a liquid, solid, or gaseous body of matter that migrates intravascularly and might occlude the distal arterial bed or capillaries.

Tumor embolization refers to the mechanical blockage of the vascular supply of a lesion by injecting liquid or particulate agents either through a catheter-based endovascular intra-arterial approach or direct percutaneous puncture (Roberson et al 1972). The first descriptions of preoperative embolization of head and neck tumors were in the early 1970s for the treatment of juvenile nasal angiofibroma and glomus jugulare tumors (Roberson et al 1972; Hekster et al 1973). Since then, preoperative embolization has become an important adjunct in the management of hypervascularized tumors and is standard practice at the authors' institution.

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