RÉSUMÉ
BACKGROUND: Hemangioblastomas (HBs) are highly vascular tumors linked to substantial morbidity and mortality. Recently, interventional neuroradiology has evolved rapidly, spurring interest in preoperative embolization as a possible HB treatment. PURPOSE: This study evaluates the effectiveness and safety of preoperative embolization in managing HB. METHODS: Adhering to PRISMA guidelines, this meta-analysis considered randomized and nonrandomized studies meeting specific criteria, encompassing intracranial HB and preoperative embolization. Primary outcomes were preoperative embolization efficacy and safety. Complications were classified as major (cerebellar ischemia, ischemic strokes, intratumoral hemorrhage, subarachnoid hemorrhage) and minor (transient nystagmus, slight facial nerve palsy, nausea, transient dysarthria, hemiparesis, hemisensory impairment, thrombotic complications, extravasation). RESULTS: Thirteen studies involving 166 patients with preoperative embolization before HB resection were included. Two studies using the Glasgow Outcome Scale (GOS) showed 5 patients with good recovery, 6 with moderate disability, and 3 with severe disability. Major complications occurred in 1% (95% CI: 0% to 3%), and minor complications occurred in 1% (95% CI: 0% to 4%). Intraoperative blood loss during resection was estimated at 464.29 ml (95% CI: 350.63 ml to 614.80 ml). CONCLUSION: Preoperative embolization holds promise in reducing intraoperative bleeding risk in neurosurgical intracranial HB treatment, primarily due to its low complication rates. Nonetheless, additional research and larger-scale studies are essential to establish its long-term efficacy and safety. These findings highlight preoperative embolization as a valuable tool for HB management, potentially enhancing future patient outcomes.
Sujet(s)
Embolisation thérapeutique , Hémangioblastome , Humains , Hémangioblastome/thérapie , Hémangioblastome/chirurgie , Embolisation thérapeutique/effets indésirables , Procédures de neurochirurgie , Soins préopératoires , Perte sanguine peropératoire , Résultat thérapeutique , Études rétrospectivesRÉSUMÉ
Resumen: Las fístulas carótido- cavernosas (FCC) son derivaciones vasculares que permiten el flujo de sangre desde la arteria carótida al seno cavernoso; pueden producir síntomas en ambos sexos a cualquier edad. Algunas fístulas se caracterizan por una conexión directa entre el segmento cavernoso de la arteria carótida interna y el seno cavernoso. Otras FCCs son durales, y consisten en una comunicación entre el seno cavernoso y una o más ramas meníngeas de la arteria carótidainterna, la arteria carótida externa , o ambas. La terapia endovascular es la modalidad de elección en estos casos.Se presenta el uso de N-butilcianoacrilato (NBCA) en una exitosaembolización transarterial de una FCC dural alimentada por ramas de las arterias carótida interna y principalmente carótida externa (Barrow tipo D) en un niño de 1 año.
Abstract:Carotid-cavernous fistulas (CCFs) are vascular shunts that allow blood to flow from the carotid artery into the cavernous sinus; they can produce symptoms in both sexes at any age. Some fistulas are characterized by a directconnection between the cavernous segment of the internal carotid artery and the cavernous sinus, other CCFs are dural, consisting of a communicationbetween the cavernous sinus and 1 or more meningeal branches of the internal carotid artery, the external carotid artery, or both. Endovascular management is the treatment modality of choice in these cases.We report the use of n-butilcianoacrilate (NBCA) in the successful transarterial embolization of a dural CCF fed by arterial branches of the internal but principally external carotid arteries (Barrow type D)in a 1 year old child.
Resumo: As fístulas carotídeas-cavernosas (FCC) são pistas vasculares que permitem o fluxo sanguíneo da artéria carótida para o seio cavernoso; pode produzirsintomas em ambos os sexos em qualqueridade. Algumas fístulas são caracterizadas por umaconexãodireta entre o segmento cavernoso da artéria carótida interna e o seio cavernoso. OutrosFCCssãodural, consistindo em umacomunicação entre o seio cavernoso e umoumais ramos meníngeos da artéria carótida, a artéria carótida externa ou ambos. A terapia endovascular é o modo de escolhanesses casos. É apresentado o uso de n-butilcianoacrilato (NBCA) em umaembolizaçãotransarterialbem sucedida de uma FCC dural alimentada por ramos das artérias carótidas internas e principalmente artéria carótida externa (tipo Barrow D) em um menino de 1 ano de idade.
RÉSUMÉ
Background In large-caliber pial macrofistulae (pMF), the combination of high blood flow velocity and large efferent artery diameter makes control over the endovascular vessel occlusion difficult and may result in the inadvertent venous passage of occlusive devices or embolic agents. Case descriptions Patient 1: A 27-year-old man presented with headache and ataxia. An infratentorial pMF supplied by both superior cerebellar arteries with venous ectasia was found. The first treatment attempt using balloons and coils failed since the position of either device could not be controlled because of a distal diameter of the feeding artery of 8 mm. In a second session a pCANvas1 (phenox) was deployed at the level of the arteriovenous connection and adenosine-induced asystole allowed the controlled injection of nBCA/Lipiodol with partial occlusion of the pMF. A remaining arteriovenous shunt was occluded under asystole in a third session. The procedures were well tolerated, the patient returned to normal and DSA confirmed the occlusion of the fistula. Patient 2: A 13-year-old boy with hereditary hemorrhagic teleangiectasia presented with an intracerebral hemorrhage from an aneurysm of the left MCA. Twelve weeks after the aneurysm treatment a feeding MCA branch (diameter 4.5 mm) of a right frontal pMF was catheterized. The macrofistula was occluded by deployment of a pCANvas1, followed by the injection of nBCAl/Lipiodol under adenosine-induced asystole. Conclusion pCANvas1 and adenosine-induced asystole allow a controlled injection of nBCA/Lipiodol for the endovascular occlusion of high-flow pMF without venous passage of the embolic agent.