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  • Updated 10.23.2022
  • Released 09.24.2012
  • Expires For CME 10.23.2025

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



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 the head, neck, and spine. The authors discuss the indications and 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 brain, head and neck, and spinal tumors to minimize intraoperative blood loss.

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

• Commonly used materials available for embolization include liquid embolics, particle embolics, and detachable coils.

Historical note and terminology

The term “embole” has historically held multiple connotations (48). In 1849, Virchow coined the use of “embolus” for the dislodgement of fragments of venous clots into circulation, generating arterial obstruction (48). Today, “embolus” refers to a liquid, solid, or gaseous substance that migrates intravascularly and might occlude the distal arterial bed or capillaries. Tumor embolization is the intentional mechanical blockage of vascular supply to a tumor via the injection of liquid or particulate agents. This can be performed either intra-arterially through a catheter-based endovascular or via direct percutaneous puncture (46). Since the first reports of preoperative embolization of juvenile nasopharyngeal angiofibroma and glomus jugulare tumors in the 1970s, the practice has become a mainstream adjunct in the management of hypervascularized tumors (46; 29).

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ISSN: 2831-9125