What is Preoperative Embolization for Tumors?

20 February 2024

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Neuro intervention, a rapidly evolving field within neurology, encompasses various procedures aimed at diagnosing and treating conditions affecting the brain, spine, and peripheral nerves. Pre-operative embolisation of tumors is a specialized technique used to reduce blood flow to a tumor before surgical resection, particularly in cases where the tumor is highly vascularized. This procedure is commonly performed in the treatment of brain tumors, such as meningiomas and hypervascular metastases.

Understanding Pre-operative Embolisation

What is Embolisation?

Embolisation is a minimally invasive procedure that involves the deliberate occlusion of blood vessels using various embolic agents. These agents can be solid particles, liquid substances, or coils. The goal of embolisation is to block or reduce blood flow to a specific area, such as a tumor, thereby shrinking its size and making surgical removal safer and more effective.

Pre-operative Embolisation in Neurosurgery

In the context of neurosurgery, pre-operative embolisation is used to treat tumors that are highly vascularized, meaning they have a rich blood supply. By reducing blood flow to the tumor before surgery, embolisation can decrease the risk of excessive bleeding during the operation, improve the surgeon’s ability to visualize and access the tumor, and potentially reduce the extent of surgery required.

Indications for Pre-operative Embolisation

Pre-operative embolisation is typically considered for tumors that meet the following criteria:

Highly Vascularized Tumors: Tumors with a significant blood supply, such as meningiomas, hypervascular metastases, and juvenile nasopharyngeal angiofibromas.

Large Tumors: Tumors that are large in size and would benefit from reduction in size before surgery.

Complex Tumors: Tumors located in challenging anatomical locations or those involving critical structures, where reducing blood flow can make surgery safer and more manageable.

Procedure Overview

Patient Evaluation and Planning

Before embarking on pre-operative embolisation, thorough patient evaluation is essential. This includes reviewing imaging studies (MRI, CT scans, angiograms) to assess tumor characteristics and vascular anatomy. A multidisciplinary team, including neurosurgeons, interventional neuroradiologists, and anesthesiologists, collaborates to plan the procedure.

Embolisation Technique

The actual embolisation procedure is performed under local anesthesia and conscious sedation. Using fluoroscopic guidance, a catheter is navigated from a peripheral artery (usually the femoral artery) to the arteries feeding the tumor. Once the catheter is in position, embolic agents are delivered to selectively block these arteries, reducing blood flow to the tumor.

Monitoring and Post-procedure Care

During the procedure, continuous monitoring of the patient’s vital signs and neurological status is crucial. Post-procedure, patients are typically monitored in an intensive care setting for a brief period to ensure there are no complications, such as bleeding or neurological deficits.

Benefits and Risks

Benefits of Pre-operative Embolisation

Reduced Intraoperative Blood Loss: By reducing blood flow to the tumor, embolisation can significantly decrease the risk of excessive bleeding during surgery, making the procedure safer for the patient.

Improved Surgical Visualization and Access: Decreasing the size and vascularity of the tumor can make it easier for the surgeon to visualize and access the tumor, potentially leading to more successful outcomes.

Potential for Less Invasive Surgery: In some cases, pre-operative embolisation can reduce the extent of surgery required, leading to faster recovery times and reduced postoperative complications.

Risks and Complications

Ischemic Complications: Embolisation carries a risk of blocking blood flow to normal brain tissue, which can lead to ischemic complications such as stroke or neurological deficits.

Bleeding: While rare, there is a risk of bleeding at the catheter insertion site or within the brain during the procedure.

Allergic Reaction: Some patients may have an allergic reaction to the embolic agents used during the procedure.

Conclusion

Pre-operative embolisation of tumors in neuro intervention is a valuable technique that can help improve surgical outcomes in patients with highly vascularized tumors. When performed by a skilled multidisciplinary team, pre-operative embolisation can significantly reduce intraoperative blood loss, improve surgical visualization and access, and potentially lead to less invasive surgeries. However, like any medical procedure, it is essential to weigh the potential benefits against the risks and ensure that patients are carefully selected and monitored throughout the process.

This blog post aims to provide a comprehensive overview of pre-operative embolisation in neuro intervention. It covers the indications for the procedure, the technique involved, the benefits and risks, and the importance of patient selection and monitoring.

Our Doctors

Dedicated IR Center for Vascular Problems in Madhya Pradesh

DR. SHAILESH GUPTA
MD, PDCC (INTERVENTIONAL RADIOLOGY) Consultant & Co-Director CVIC (Center Of Vascular & Interventional Care)

DR. ALOK KUMAR UDIYA
MD Radiology, PDCC (Neuro intervention Radiology), PDCC ( HPB Intervention Radiology) FINR (Switzerland) & EBIR
Endovascular Surgeon & Consultant Interventional Neuroradiologist at Care CHL Hospital, Indore Co-director CVIC( center for vascular and interventional care) https://interventionradiologyindore.com/

DR. NISHANT BHARGAVA
Consultant Intervention Radiologist
MD Radiology, PDCC ( Neuro intervention Radiology), FINR ( Fellowship in Neuro intervention Radiology)
Co-director CVIC(Center for Vascular and Interventional Care)