Search

To evaluate the safety and efficacy of preoperative renal artery embolization of renal cell carcinoma in reducing intraoperative blood loss during subsequent partial nephrectomy through a systematic review and meta-analysis of current literature.The PubMed database was searched for articles published from 1970 to 2018 describing patients with renal cell carcinoma who underwent partial nephrectomy with and without preoperative embolization of the tumor. Demographic data, procedural techniques, and surgical outcomes were obtained when available. A random-effects meta-analysis was performed to determine estimated blood loss in both groups of patients.The literature search identified 14 relevant articles for systematic review, of which 4 articles provided sufficient data to be included in the meta-analysis. 270 patients (173 males, 97 females) underwent partial nephrectomy for RCC, of whom 222 received pre-operative embolization. There were 48 patients in our cohort that underwent partial nephrectomy for RCC without preoperative embolization. Random-effects meta-analysis demonstrated a significant difference between EBL in patients undergoing RAE prior to partial nephrectomy vs partial nephrectomy without preoperative embolization, with EBL of 154.0 ± 22.6 mL (n = 222) and 353.4 ± 69.6 mL (n = 478), respectively (p 0.0001). Major complications occurred in 4.9% of patients undergoing pre-operative embolization followed by partial nephrectomy, whereas major complications occurred in 10.9% of patients undergoing partial nephrectomy without embolization (p = 0.01). Minor complications occurred in 5.8% of patients undergoing embolization and partial nephrectomy and in 19.0% of patients undergoing partial nephrectomy without embolization (p 0.0001).Renal artery embolization prior to surgical resection of renal cell carcinoma is safe and significantly reduces intraoperative blood loss in patients undergoing partial nephrectomy.

Solitary fibrous tumors are rare mesenchymal neoplasms with highly recurrence rates after intratumor resection. We report 2 cases of solitary fibrous tumors treated with combination therapy with embolization and en bloc laminectomy using thread saw. To the best of our knowledge, this is the first such report. In the 2 cases, the hypervascular tumors were located in the spinal process and infiltrating the multifidus. Preoperative embolization was useful for decreasing intraoperative bleeding, and using thread saw was an ideal technique for deciding the cut surface height of the pedicle to achieve gross total resection.

Carotid body tumors (CBTs) are rare tumors in the neck. Surgical resection is the gold standard of treatment. Surgical resection may be complicated by bleeding. Preoperative embolization has recently been introduced for the treatment to reduce the quantity of blood loss; however, the outcomes of this procedure are still under debate. In this article, we have presented the outcomes of patients who underwent surgical resection for CBT without undergoing preoperative embolization in our institution.This retrospective study reviewed 67 tumor resection cases who underwent surgical resection for CBTs without undergoing preoperative embolization. Tumor classification was performed as per the Shamblin classification. The demographic, clinical characteristics, and the operative information about the patients were retrieved from the patient records. The obtained data were analyzed with descriptive statistics.The study included 12 male and 55 female patients. The mean age was 51.95 ± 16.59 years. Of the surgically resected tumors; 11 (16.4%) were Shamblin type I, 30 (44.8%) were Shamblin type II, and 26 (38.8%) were Shamblin type III. The mean duration of operation was 109.10 ± 32.36 min. The volume of intraoperative blood loss in the Shamblin type I, type II, and type III groups were 98.64 ± 23.46 cc, 215.33 ± 75.74 cc, and 351.73 ± 62.51 cc, respectively, and they were significantly different among the groups (P 0.001). The volume of postoperative blood loss in the Shamblin type I, type II, and type III groups were 34.09 ± 10.44 cc, 53.00 ± 20.02 cc, and 62.50 ± 25.11 cc, respectively, and they were significantly different among the groups (P = 0.003). Cranial nerve injury developed in 10 (15.0%) patients. Postoperative stroke developed in 2 (3%) patients. No mortality or persistent nerve injury was observed in association with the injury in the patients during the 1-year follow-up period.CBTs can be surgically resected safely and effectively without a need for preoperative embolization.

Background Primary intracranial rhabdomyosarcoma is a very rare malignant tumor. Owing to moderately vascular and firm characteristics of the tumor, complete removal without complications is often difficult. In pediatric patients, the volume of total blood is less than in adults, and minimal intraoperative hemorrhage is desirable. Case Description A 6-year-old boy presented with ataxia and was found to have a large cerebellopontine angle tumor and hydrocephalus. The patient underwent preoperative coil embolization of the anterior inferior cerebellar artery to decrease tumor vascularity, and gross total removal was achieved on the same day via a suboccipital approach. Pathologic diagnosis was rhabdomyosarcoma. Conclusions Successfully resection of primary intracranial rhabdomyosarcoma was achieved after preoperative embolization. Tumor vascularity was significantly reduced, and gross total removal was achieved safely with less hemorrhage.

The optimal management of complex, Spetzler-Martin Grade 5 arteriovenous malformations (AVMs) remains a challenge, despite the availability of endovascular, surgical and radiosurgical treatment options. In cases requiring treatment due to progressive neurological deficit or recurrent hemorrhage, preoperative embolization may be an extremely useful adjunct to definitive surgical resection, and is usually accomplished via the transarterial route using liquid embolysate. However, this treatment approach often mandates access to distal arterial pedicles that can be technically challenging by standard endovascular approaches. This video describes a left parietal craniotomy for direct access microcatheterization and embolization of an otherwise endovascularly inaccessible Spetzler-Martin Grade 5 AVM prior to definitive surgical resection. The case was performed in the hybrid operative suite with biplane intraoperative angiography. Technical considerations, operative nuances and outcomes are reviewed.

Introduction and importance Phyllodes tumors (PT) account for less than 1% of all breast tumors. Giant PTs can lead to breast disfigurement, tumoral ulceration, and bleeding. Outright surgical excision can be challenging or unsafe. Preoperative transarterial embolization (TAE) has a role but data on its use in the management of PT is limited. Case presentation A 43-year-old female presented with a 28 cm fungating, necrotic, benign PT on her left breast that eventually developed tumoral bleeding leading to hemodynamic instability. Preoperative TAE controlled the bleeding and allowed the safe performance of mastectomy. A literature review of preoperative TAE of PTs is also presented including the addition of a chemotherapeutic agent in malignant types. Clinical discussion PTs are rare and comprise only 2.5% of all fibroepithelial breast lesions. Tumoral bleeding causing severe anemia is one of the most common presentations of massive (≥20 cm) PTs, especially when neglected. Indications for preoperative TAE include (1) to halt rapid tumor growth, (2) to control active/persistent tumoral bleeding, and (3) to shrink the tumor size and allow successful resection with negative margins, and avoidance of skin grafting. Post-TAE side effects include fever, chest pain, gradual/expanding tumor necrosis, decrease in tumor weight, and diminished tumoral abscess/discharge, and loss of tumoral vessel elasticity. Conclusion Neglected PTs can reach an alarming size. Preoperative TAE is a safe and effective method of controlling life-threatening tumoral hemorrhage and decreasing the size of PTs thereby allowing definitive resection while avoiding skin grafting and/or flap reconstruction., Highlights • Giant phyllodes tumors (PT) of the breast can lead to breast disfigurement, tumoral ulceration, and bleeding • Tumoral bleeding can lead to hemodynamic instability and makes outright surgical excision challenging or unsafe • Preoperative transarterial embolization is safe and effective to control bleeding PTS and allow definitive resection

This report presents a patient with a cerebellar hemangioblastoma associated with obstructive hydrocephalus and a saccular superior cerebellar artery (SCA) aneurysm who was successfully treated using a three-stage approach that included ventriculoperitoneal shunting, preoperative endovascular embolization of the tumor vasculature and aneurysm with a low viscosity non-adhesive liquid embolic agent, and total microsurgical tumor removal. Removal of these tumors is associated with a high risk of profuse intraoperative blood loss, cerebral edema, and other equally dangerous complications. Our case was complicated by a tumor feeder aneurysm, which increased the risk of spontaneous subarachnoid hemorrhage and intraoperative aneurysm rupture. A three-stage approach allowed radical and safe removal and resulted in improved neurological symptoms.

Cerebral arteriovenous malformations (AVMs) are a specific set of lesions with high variability in terms of site, size, angio-architecture, flow dynamics, and involvement of eloquent areas. Although there is uncertainty about the optimal treatment for unruptured AVMs, surgery preceded by preoperative embolization has been reported as a useful treatment option for these injuries. The objective of this study is report the results and experience of combine preoperative embolization and surgical resection in a consecutive series of unruptured cerebral AVMs. Between 2010 and 2018, 35 unruptured AVMs were treated by staged embolization and subsequent surgical treatment. We review the location, size of AVMs, details of pre-surgical embolization, complications, and clinical outcomes. All AVMs were supratentorial. The average size of AVMs was 3.1 cm. The average of embolization sessions were 1.7. The mean rate of obliteration related to embolization at the time of surgery and morbidity were 96.5% and 11.4%, respectively. Surgery was performed within 14.6 days on average after the last embolization. In our experience, preoperative embolization with Onyx provide an effective and safety for the surgical treatment of unruptured AVMs. Careful evaluation of morphology, an individualized strategy in the embolization process, and full cooperation neuroendovascular-neurosurgical team, are necessary for good end outcome.

Highlights • Gastric remnant reconstruction after esophagectomy is one of the standard procedures. • The right gastroepiploic artery (RGEA) is crucial for the gastric remnant. • Gastric remnant reconstruction was applicable for a patient with occluded RGEA. • We performed left gastric artery embolization for preoperative conditioning. • We also performed intraoperative left gastroepiploic artery supercharge., Introduction Gastric remnant reconstruction is commonly used for esophagectomy reconstruction. However, standard reconstruction cannot be performed in some patients with a specific medical history. We report a case of esophagectomy and gastric remnant reconstruction with left gastroepiploic artery (LGEA) supercharge to treat esophageal cancer in a patient in whom the right gastroepiploic artery (RGEA) had previously been occluded. Presentation of case A 65-year-old man underwent endoscopic submucosal dissection for thoracic esophageal squamous cell carcinoma. He was diagnosed with pathological T1b cancer with lymphatic invasion and a positive horizontal margin, and needed curative resection. He had previously undergone RGEA embolization to treat a pseudoaneurysm caused by chronic pancreatitis. We successfully performed esophagectomy and gastric remnant reconstruction with preoperative left gastric artery embolization and intraoperative LGEA supercharge. Discussion An absent RGEA blood supply is not always a contraindication for gastric remnant reconstruction when the collateral blood flows are well developed and supercharge can maintain the blood supply to the gastric remnant. Conclusions Gastric remnant reconstruction with preoperative selective arterial embolization and intraoperative supercharge represents one of the options for high-risk patients with an altered gastric blood supply.

Introduction While preoperative embolization is often reserved for large and highly vascular tumors in order to minimize blood loss, its safety and efficacy in the treatment of hemangioblastomas (HB) is unclear. We present the largest systematic review focusing on the safety and outcome of preoperative embolization of intracranial HB. Materials and methods To identify all cases of preoperative embolization for HB, a literature search was conducted via Medline (OVID and PubMed), Scopus, Embase, and Web of Science. Studies that were in English, included intracranial hemangioblastomas treated with preoperative embolization and provided sufficient disaggregated clinical data for each patient were included. Historical control patients with non-embolized intracranial HB undergoing resection were similarly identified. Results A total of 111 patients that underwent preoperative embolization of HB prior to planned resection were identified. Patient age ranged from 12 to 72 years, with a cohort of 63% males and 36% females. Nine studies comprising 392 non-embolized patients were included as controls. Gross total resection was achieved in 83.7% of embolized and 95.6% of non-embolized patients. Intraoperative blood transfusion was required in 15.3% of embolized and 0.51% of non-embolized controls, while rates of post-operative hemorrhage were 8.4% and 1.6%, respectively. Complication rates from embolization were 11.7% and following consequent surgery were 20.7%. Discussion Embolization did not increase rates of gross total resection, decrease estimated blood loss, or decrease incidence of complications. Not only does embolization fail to mitigate surgical risks, the embolization procedure itself carries significant risk for complications. Embolization should not be standard of care for intracranial HB.

Background: Ossifying fibroma arising in the sinonasal tract is rare. Its treatment includes complete resection; however, this can be challenging to perform due to the well-vascularized nature of the fibroma. Some surgical techniques can control intraoperative hemorrhage; however, to date, no reports have assessed the use of preoperative embolization. Methods: We report a case of a child with ossifying fibroma arising from the ethmoid sinus, which was resected by endoscopic surgery using preoperative transarterial embolization. Conclusions: Embolization was effective in decreasing intraoperative hemorrhage. No complications related to the procedure or operation were encountered. Preoperative embolization should be considered for better control of the bleeding that occurs in ossifying fibromas, similar to that in other well-vascularized tumors. Keywords: Preoperative embolization, Pediatric ossifying fibroma, Paranasal ossifying fibroma, Endoscopic skull base surgery

Highlights • Hemophilic pseudotumor is a rare complication of Hemophilia A and B. • Diagnosis requires a high index of suspicion-especially in non-hemophilic patients. • Radiographic findings are similar to that of malignant tumors. • Surgical intervention remains the mainstay of treatment. • Pre-operative embolization has been shown to reduce intra-operative bleeding., Introduction Hemophilic pseudotumor is a rare but well documented complication seen in approximately 1–2% of patients with hemophilia. The incidence continues to decrease, likely because of increasingly sophisticated techniques in managing factor deficiency. We present a case of hemophilic pseudotumor in a patient without hemophilia, an exceptionally rare entity, and outline a hybrid approach to treatment. Presentation of case The patient presented with a left sided iliopsoas mass and associated radiculopathy, with a history of a poorly characterized bleeding diathesis and Noonan’s syndrome. He had no history of trauma and was not being treated with anti-coagulation. Of note, factors VIII, IX and XI were normal. An open biopsy was consistent with hemophilic pseudotumor. The patient underwent a hybrid procedure of preoperative embolization of the left internal iliac and left deep circumflex arteries followed by surgical debridement and resection, with an excellent outcome. Discussion Hemophilic pseudotumor is rarely seen in patients with hemophilia, and even less frequently in patients without. Trauma is often the inciting event. A high index of clinical suspicion is required in order to secure the diagnosis, as the radiographic appearance is non-specific. Our patient had no history of trauma, although we question whether his underlying bleeding diathesis may have predisposed him to developing the pseudotumor. Surgery remains the cornerstone of management in these cases. Conclusion Within the literature, there are only two other cases of hemophilic pseudotumor occurring in a non-hemophiliac patient, highlighting the rarity of this case and the associated diagnostic dilemma.

Intralobar pulmonary sequestration is a rare congenital malformation, conventionally managed by surgical resection. Recently, the endovascular embolization has been proposed for the definite treatment of this disease. Additionally, preoperative embolization of aberrant arteries to minimize the risk of serious intraoperative haemorrhage has also been described. We report the case of 43-year old female patient who presented with cough and haemoptysis, and was successfully treated with endovascular embolization followed by a Video-assisted thoracoscopic wedge resection. Keywords: Endovascular embolization, Intralobar pulmonary sequestration

We describe the endovascular exclusion and surgical resection of an intralobar pulmonary sequestration supplied by an aneurysmal feeding vessel from the aorta. Pulmonary sequestration is a rare congenital anomaly, and the presence of an aneurysmal feeding vessel is even rarer. The possibility of life-threatening hemorrhage resulting from failure to control these aberrant vessels has led many to pursue preoperative embolization. The anatomy in the patient described here was not deemed suitable for embolization, and we thus elected to pursue a novel approach. This case also demonstrates the diagnostic utility of magnetic resonance imaging for delineating the vasculature of pulmonary sequestrations when contrast-enhanced computed tomography is contraindicated.

Background Transcranial surgery is considered more appropriate than an endonasal endoscopic approach (EEA) for a large cavernous sinus meningioma with lateral extension. Case presentation A 6-cm-diameter hypervascular meningioma around cavernous sinus invaded the orbital apex and infratemporal fossa. 80% of the tumor was removed without too much blood loss via endoscopic endonasal transpterygoidal-infratemporal approach. Preoperative embolization from some feeding arteries was done, and 80% of the tumor staining disappeared. Discussion Tumor removal rates for giant meningioma are worse with EEA than with the transcranial approach because of various anatomical limitations and blood control. Recently, EEA has become more widely used with approaches such as the transpterygoidal approach. The operation can be done safely with preoperative embolization because the operative view is clear without bleeding. Conclusion Preoperative embolization for a large hypervascular tumor makes EEA more effective. A giant meningioma can be removed by EEA if the anatomical limitations can be identified and approached safely and effectively.

Highlights • Preoperative segmental embolization of the hepatic artery before PPPD for a patient with a replaced left hepatic artery encourages the growth of collateral blood supply, allowing radical resection including the vessels, obviating the need for arterial reconstruction., Introduction Radical resection of bile duct carcinoma may require resection of hepatic arteries. Preoperative segmental embolization of the hepatic artery for resection of hilar cholangiocarcinoma has been reported. We report a patient with bile duct carcinoma infiltrating the proper hepatic artery. Presentation of case A 66-year old male with jaundice was diagnosed with mid-distal bile duct carcinoma. A replaced left hepatic artery originated from the left gastric artery. Pylorus-preserving pancreaticoduodenectomy (PPPD) with combined resection of hepatic artery was planned. To promote the development of collateral blood flow after excision of the hepatic artery, preoperative segmental embolization of the proper hepatic artery was performed. The patient underwent PPPD with concurrent resection of the common hepatic, right hepatic, and middle hepatic arteries without arterial reconstruction. He received adjuvant chemotherapy with gemcitabine for six months and is alive three years after surgery without tumor recurrence. Discussion The growth of collateral vessels after selective embolization of the proper hepatic artery has been used for hilar lesions and bile duct lesions. Resection of the hepatic artery without the need for complex arterial reconstruction, allowing a radical resection, may have contributed to this patient's relatively unremarkable recovery and long-term survival. Retroperitoneal mobilization of the pancreatic head and duodenum must be limited as important collaterals may originate in that area. Conclusion Preoperative segmental embolization of the hepatic artery before PPPD for a patient with a replaced left hepatic artery encouraged the growth of collateral blood supply, allowing radical resection including the vessels and obviated the need for arterial reconstruction.

In this article, the authors review general principles and technical details of preoperative embolization of various hypervascular head, neck, and spinal tumors encountered in contemporary neuroendovascular practice. Indications, treatment goals, techniques, outcomes, and complications are discussed, and illustrative case examples are presented.

We report two patients with a carotid body paraganglioma that extended to the skull base, a position that is surgically inaccessible by means of a traditional lateral cervical approach. In both patients we were able to remove the lesion by performing a double mandibular osteotomy. Both patients underwent preoperative embolization to reduce the mass. In our experience, this approach has allowed a safe radical excision of exceptionally high lesions with only minor permanent nerve damage. In our opinion this advantage definitely outweighs the consequences of the increased invasiveness of this technique.

Substantial intraoperative bleeding during surgical removal of carotid body tumor may be a major problem in the management of these highly vascularized tumors. Traditional preoperative embolization via a transarterial access has proved effective but is often limited by complex vascular anatomy and small feeding vessels that is difficult to catheterize. We report two cases of carotid body tumor treated with direct puncture and intratumoral injection of N-butyl cyanoacrylate glue (NBCA) assisted with balloon protection technique for preoperative devascularization. The result was impressive and minimal bleeding loss during surgery was observed.

Malignant peripheral nerve sheath tumors are rare tumors compromising about 5% of all malignant soft tissue tumors. Treatment of these tumors is surgical but surgical resection is not always easy. We are presenting a low grade retroperitoneal malignant peripheral nerve sheath tumor in which we used selective arterial embolization before surgery and surgical resection became possible.

Surgical excision of hypervascular central nervous system (CNS) tumors can be daunting and is associated with the potential for staggering blood loss. The need to mitigate intraoperative tumoral hemorrhage has fostered the refinement of neuroendovascular techniques for preoperative embolization of tumors. Since these techniques were first described in the early 1970s, the field has matured rapidly, with advances in microcatheter technology and ongoing improvements in the design of embolisates. Nonetheless, the tenets fundamental to embolization of tumors are not novel. They include an understanding of neurovascular anatomy and of the natural history and behavior of tumors.

Juvenile nasopharyngeal angiofibroma (JNA) is one of the most common benign nasal cavity tumors of adolescence. It exhibits a strong tendency to bleed and despite being microscopically benign, its behavior is locally aggressive. Preoperative embolization is helpful to minimize intraoperative bleeding. However, embolization procedure may have some important thromboembolic complications such as central retinal artery occlusion. In this article, a young male with juvenile nasopharyngeal angiofibroma, who lost his vision in the left eye following embolization was presented and the possible therapeutic options in such a complication were discussed.

Approximately 20 cases of malignant vagal paragangliomas (MVP)have been reported in English literature. Malignancy is based on the presence of metastases. A careful preoperative evaluation is necessary to detect multicentricity and/or significant production of catecholamines. A new case of MVP treated with embolization and surgery is presented and the literature discussed. It is concluded, that preoperative embolization followed by radical surgical resection is a rational treatment of patients with unilateral MVP.

Preoperative embolization was performed in 34 patients with nasopharyngeal angiofibroma (NAF). Thirty-seven embolization procedures were done in those patients (three patients had tumor recurrence and repeated embolizations were performed). Embolization was done using Gelfoam (seven embolizations), contour particles (24 embolizations) and Ivelon (six embolizations). The internal maxillary artery (IMA) was embolized bilaterally in four patients (four embolizations), and unilaterally in 30 patients (33 embolizations). In 25 patients, intraoperative blood loss at primary surgery was insignificant (no blood transfusion was required) while in nine patients, the intraoperative blood loss ranged from 400 to 1500 ml (average 650 ml), and the average blood transfusion was 944.4 ml. Only three patients showed recurrence of the tumor after primary surgery (8.8%). Minor complications were seen in most of the patients in the form of mild to moderate local pain in the vascular territory of the embolized artery and slight temperature elevation. Other minor complications included nausea in three patients and local subcutaneous edema in only one patient. A major complication was encountered in only one patient who had left retinal artery occlusion and temporary visual loss due to embolization of the left ophthalmic artery. The results indicated that pre-operative embolization of the internal maxillary artery in patients with nasopharyngeal angiofibroma is a relatively safe technique, effective in reducing intraoperative blood loss and contributes to improving surgical results. We recommend it as a routine pre-operative adjunct to surgery for nasopharyngeal angiofibroma.

Preoperative embolization of meningiomas has been performed in order to reduce surgical hemorrhage during the removal of these vascularized tumors. In this paper we emphasize the fact that occlusion of the tumoral vessels by artificial emboli produces an ischemic necrosis that greatly helps tumor exeresis. This is especially useful in meningiomas of certain localizations requiring complex surgical approaches. In our case, a giant ponto-cerebellar meningioma was dried up totally and then removed with relative ease through a conventional suboccipital lateral craniectomy. The technique, indications and control of preoperative embolization are reviewed.

Over the past 2 decades, the application of endovascular techniques has revolutionized the care of patients with midline facial and skull base diseases. These techniques have been applied as adjuncts to surgery or as definitive, stand-alone therapies. This article details the endovascular techniques used in the skull base and midline facial region to treat vascular lesions such as aneurysms and congenital vascular malformations, traumatic conditions, and tumors.

Castleman's disease is a rare form of lymph node hyperplasia most commonly presenting as a solitary hypervascular mediastinal mass. Surgical resection is the treatment of choice, but this can be associated with significant blood loss due to its hypervascularity. We report two cases with a preoperative diagnosis of mediastinal Castleman's disease in whom preoperative embolization with Trisacryl gelatin microspheres (Biosphere Medical, Rockland, MA) was performed. Compared with the literature, a decrease in the amount of perioperative bleeding was noted in both cases.

Background Glioblastoma can mimic various pathologies, including arteriovenous malformation, hemorrhage from ischemic stroke, cerebral contusion, metastatic disease, lymphoma, and infection. The literature is limited regarding diagnostic confusion with meningioma. Herein, we present 2 patients that exhibited imaging, including cerebral angiography during preoperative embolization, which was consistent with meningioma, but where final surgical diagnosis revealed glioblastoma. Case Description Case 1 was a 57-year-old woman presenting with headache, ataxia, and memory lapses for the past month. Brain magnetic resonance imaging (MRI) demonstrated a heterogeneous-enhancing right temporoparietal mass with broad contact along the right tentorium, cerebrospinal fluid (CSF) cleft sign, and dural tail sign—consistent with meningioma. Patient underwent angiography with successful polyvinyl alcohol foam (PVA) particle embolization of the petrosquamosal branch of the right middle meningeal artery (MMA) and meningeal branch of the right occipital artery, resulting in significant devascularization of the tumor blush. Subsequently, the patient underwent tumor resection, where pathology revealed glioblastoma. Case 2 was a 60-year-old man presenting with right hemiparesis. Brain MRI demonstrated a left parasagittal, heterogeneous-enhancing mass abutting the falx with a dural tail sign—consistent with meningioma. Patient underwent angiography with successful PVA particle embolization of the left MMA, resulting in significant devascularization of the tumor blush. Patient underwent a tumor resection where pathology revealed glioblastoma. Conclusions Glioblastoma can mimic meningioma on MRI with dural tail sign, CSF cleft sign, and broad dural contact. Moreover, cerebral angiography can reveal tumor feeders commonly associated with meningioma. These features can contribute to diagnostic confusion. Based on these 2 cases, preoperative embolization of tumor feeders is possible with glioblastoma.

SUMMARY Diagnostic angiography is a valuable tool for diagnosis and delineation of uncontrollable bleeding of vascular tumors in the maxillofacial region. Combined with information gained from CT and MRI, the surgical approach can be carefully planned. Improvement in interventional angiographic techniques has made embolization a safe alternative to surgery for the treatment of uncontrollable epistaxis. Preoperative embolization of juvenile angiofibroma can substantially decrease blood loss, making the surgical resection safer and perhaps obviating the need for blood transfusions.

Isobutyl-2-cyanoacrylate (IBC) is an acrylic monomer which polymerizes quickly in contact with blood. It has rarely been used as an embolic material and never in embolization of renal cell carcinoma. IBC was used in experimental transcatheter embolization of rat kidneys and in 2 clinical cases of preoperative embolization of renal cell carcinoma. IBC is a substance which can produce a very efficient and lasting embolization; no significant complication was observed.

Twenty-nine cases of liver malignancies, 26 hepatoblastomas (HB) and 3 hepatocarcinomas (HC), were treated in a 13-year period. All children were submitted to operation but four had nonresectable tumors, even after chemotherapy. Surgery in the 25 cases consisted of right lobectomy in 14, a left lobectomy in 9, and a tumorectomy in 2; a secondary operation had to be performed in 5 cases, either because of histologic doubt on the cut section of the presumed normal parenchyma, or for local recurrence. Preoperative chemotherapy, instituted on a routine basis since 1982, did appear to facilitate surgery in otherwise inoperable tumors. The benefits of preoperative embolization, done for three children, were minimal. Ten children died, one in the immediate postoperative period, eight others from the disease, and one from a complication of chemotherapy. Follow-up for the 18 surviving children, all recurrence and metastasis-free, with normal alphafetoprotein (AFP) is less than 2 years for four and from 2 to 11 years for 14. One teen-age girl, with a fibrolamellar carcinoma has just recently been reoperated because of recurrence three years later. In spite of the fact that 6 out of 7 children operated without adjunctive treatment are cured, a systematic course of preoperative chemotherapy has been prescribed in the more recent cases. Follow-up for these is yet too short.