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Carotid body tumors (CBTs) are rare, hypervascular neuroendocrine neoplasms that can lead to significant complications during surgical resection due to the high risk of bleeding. We present the case of a 64-year-old male with a palpable neck mass on the left side, diagnosed as a CBT through imaging studies. Given the tumor's increasing size and rich vascularization, percutaneous preoperative embolization with Onyx under ultrasound and angiographic guide, was performed to minimize intraoperative complications. Forty-eight hours later, the tumor was surgically resected with minimal blood loss and no injury to cranial nerves or the carotid bifurcation.

Objectives: The aim of this paper is to describe our experience in the embolization of hypervascular giant thoracic tumors before surgical excision. Methods: A single-center retrospective review of five trans-arterial preoperative embolization procedures executed between October 2020 and July 2024. Patients' demographics, anatomical aspects, feasibility, technique, and outcomes were reviewed. Results: In all cases, accurate targeting and safe embolization was achieved, with satisfactory devascularization evaluated with post-procedural angiography and with minimal blood loss during subsequent surgical operation. Conclusions: In our experience, preoperative embolization of giant thoracic masses has been technically feasible, safe, and effective in reducing tumor vascularization, thus facilitating surgical treatment. This approach should be evaluated as an option, especially in patients with hypervascular thoracic tumors. [ABSTRACT FROM AUTHOR]

Background: Preoperative vascular embolization is an effective strategy for managing meningiomas, neck paragangliomas, renal cell carcinomas, and bone metastasis by reducing the intraoperative bleeding volume and operation time. Although hypervascular tumors also occur in the pancreas, preoperative embolization for these tumors is not commonly practiced. We herein present a case of a giant serous cystic neoplasm (SCN) of the pancreas with significant arterial vascularity that was managed with preoperative interventional radiology and subsequently resected via pancreaticoduodenectomy. Case presentation: A 60-year-old man presented with an 8-cm hypervascular tumor located at the head of the pancreas, identified as an SCN on pathologic examination. The tumor had increased by 13 mm over 5 years, necessitating surgical intervention. Computed tomography revealed a substantial blood supply to the tumor from the dorsal pancreatic artery and gastroduodenal artery, both branches of the superior mesenteric artery. To mitigate the risk of severe intraoperative bleeding from this giant hypervascular tumor, branches of the dorsal pancreatic artery and gastroduodenal artery were embolized using metallic coils and further secured using a gelatin sponge 1 day prior to pancreatectomy. During the laparotomy, the tumor appeared to have decreased in size, likely because of reduced distension and congestion. Despite significant adhesions to surrounding tissues secondary to prolonged compression and inflammation, the pancreaticoduodenectomy was completed successfully in 5 h and 15 min with blood loss of 763 mL. The patient was discharged on postoperative day 15 without complications. Conclusions: Preoperative arterial embolization for hypervascular pancreatic tumors might control the risk of massive intraoperative bleeding, contributing to a favorable postoperative outcome. Utilizing interventional radiology for preoperative inflow control is one of the beneficial strategies for pancreatectomy in patients with a giant SCN. [ABSTRACT FROM AUTHOR]

This is a unique case of metastatic pheochromocytoma of the cervical spine treated with preoperative embolization and subsequent en bloc resection. A 65-year-old man with metastatic pheochromocytoma presented with two weeks of worsening neck pain, left arm and leg weakness and paresthesia, and urinary incontinence. Magnetic resonance imaging showed a metastatic osseous lesion at C6 with severe stenosis and spinal cord compression. The patient underwent successful preoperative angiographic embolization with a liquid embolic agent followed by C5-C7 laminectomy, en bloc tumor resection, and C3-T2 posterior spinal fusion. Six weeks postoperatively, the patient reported improving strength and resolving neck pain and paresthesias. While there is no standard paradigm for the treatment of metastatic pheochromocytomas of the cervical spine, preoperative embolization may minimize intraoperative blood loss and hemodynamic instability during subsequent surgical resection. [ABSTRACT FROM AUTHOR]

Abstract Background Carotid body tumors are uncommon neuroendocrine growths near the carotid bifurcation. While some advocate preoperative embolization to minimize bleeding, others avoid it due to complications. This study shares the experience of a single center in managing patients with carotid body tumors without practicing preoperative embolization. Methods This was a cross-sectional study of patients with carotid body tumors managed between 2020 and 2024. Data were collected from the hospital’s registry. When necessary, routine blood tests, neck ultrasonography, and computed tomography scans were conducted. The tumors were categorized according to Shamblin’s classification. The average duration of follow-up was 20 months. Results The study involved 25 patients, 22 (88%) females and 3 (12%) males. Their ages ranged from 27 to 85 years old. Twenty (80%) cases presented with neck swelling, and six (24%) had a positive medical history. Tumors were mainly on the right side (52%), with 20 (80%) showing ill-defined neck masses. Tumor sizes ranged from 1.5 to 7 cm, with Shamblin type II tumors being discovered in the majority of cases (72%). Types of tumors were significantly associated with the tumor size (p-value

Background: Carotid body tumors are uncommon neuroendocrine growths near the carotid bifurcation. While some advocate preoperative embolization to minimize bleeding, others avoid it due to complications. This study shares the experience of a single center in managing patients with carotid body tumors without practicing preoperative embolization. Methods: This was a cross-sectional study of patients with carotid body tumors managed between 2020 and 2024. Data were collected from the hospital's registry. When necessary, routine blood tests, neck ultrasonography, and computed tomography scans were conducted. The tumors were categorized according to Shamblin's classification. The average duration of follow-up was 20 months. Results: The study involved 25 patients, 22 (88%) females and 3 (12%) males. Their ages ranged from 27 to 85 years old. Twenty (80%) cases presented with neck swelling, and six (24%) had a positive medical history. Tumors were mainly on the right side (52%), with 20 (80%) showing ill-defined neck masses. Tumor sizes ranged from 1.5 to 7 cm, with Shamblin type II tumors being discovered in the majority of cases (72%). Types of tumors were significantly associated with the tumor size (p-value < 0.05). Blood transfusion was required in five cases (20%), three from type III and two from type II, with none from type I (p-value = 0.001). Temporary neurological deficits occurred in 3 cases (12%). No functional impairment or mortality was recorded. Conclusions: Carotid body tumors are rare tumors with an unknown etiology. Operation without practicing preoperative embolization may be feasible with an acceptable outcome. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Palliative surgical resection of extra‐calvarial metastatic lesions from renal cell tumors is crucial for controlling metastatic spread, improving quality of life, and preventing associated morbidity. Careful surgical planning, including selective preoperative embolization and controlled resection around critical structures such as the sagittal sinus, is essential for successful outcomes. Cranioplasty with Titanium mesh and bone cement post‐resection can provide symptomatic relief, better cosmesis, and overall improved quality of life. Renal cell carcinomas are aggressive tumors with distant systemic disease. The calvarium appears to be an unusual and rare site for distant metastasis. The treatment modalities are challenging and out of the normal realm for the management of these tumors. We report a case of a 63‐year‐old woman with a previous history of nephrectomy who presented with symptoms of severe headaches, and swelling of bi‐frontal and bi‐parietal scalp regions due to multifocal extracalvarial disease. Preoperative bilateral superficial temporal artery embolization was performed to control the intraoperative bleeding. Surgical technique has been described with the critical steps involved, and a literature review has been conducted. Palliative tumor resection surgery was performed to improve the patient's quality of life as well as to confirm the histopathological diagnosis. Gross total resection of the extracalvarial metastatic tumor was achieved. Biopsy confirmed renal cell tumor with the clear cell subtype. The patient recovered well from her surgery with slow healing of the scalp wound. At 6‐month follow‐up, no recurrence of the extracalvarial disease was observed on serial imaging. Extracalvarial metastasis is a rare presentation in renal cell carcinoma. Considering the inherent radioresistant nature of the tumor, palliative surgical resection can be offered to control the metastatic spread, relieve agonizing pain symptoms, and to improve the quality of life. Preoperative embolization helps to decrease intraoperative blood loss. Moreover, palliative surgical resection of extracalvarial diseases helps to treat the metastasis as well as avoiding the associated morbidity that may occur if left untreated. [ABSTRACT FROM AUTHOR]

Objectives: The superiority and usefulness of liquid material over particles for embolization have been a topic of debate due to differences in materials and techniques. This study aimed to identify the complications and outcomes associated with both embolization materials. Methods: This retrospective multicenter cohort study included 93 patients from an endovascular treatment registry, treated from January 1, 2018 to May 31, 2022. It included patients who underwent preoperative embolization for meningioma, solitary fibrous tumor/hemangiopericytoma, and hemangioblastoma. Data for patient characteristics, procedural factors, complications, and outcomes were collected from medical records. Results: A tortuous access route was the only factor independently associated with complications (p = 0.020). Although liquid material was more frequently used for embolization in relatively high-risk conditions, complication rates did not differ significantly between the groups (p = 0.999). In the liquid material group, the tip of the microcatheter could be guided closer to the tumor (p <0.001) using a distal access catheter and flow-guide microcatheters. The subgroup middle meningeal artery embolization had less operative bleeding in the liquid material group (p <0.001), whereas the particles group exhibited less intraoperative blood loss than the liquid material group (p = 0.006). Conclusion: The vascular tortuosity of the access route was only associated with complications in preoperative tumor embolization. Liquid material and particles showed no difference in complication rates. The use of particles in embolization may reduce intraoperative bleeding, but not in all cases can it be used safely. Therefore, a thorough understanding of the characteristics of both approaches and their relative advantages in clinical practice is essential to opt for the appropriate material according to the case. [ABSTRACT FROM AUTHOR]

To analyze and compare the intraoperative and post-operative outcomes of "on-clamp" laparoscopic partial nephrectomy (LPN) with "preoperative super-selective angioembolization" before LPN. This randomized clinical study was conducted at Gauhati Medical College Hospital, Guwahati, India, between November 2021 and November 2023. Adult patients of either gender diagnosed with T1 renal tumors were included in the study. All patients underwent diethylenetriamine pentaacetate scan preoperatively and at 1-month follow-up. The patients were randomized using a parallel group design with an allocation ratio of 1:1 to receive either preoperative angioembolization followed by LPN or conventional "on-clamp" LPN. Demographic and baseline parameters were recorded along with pre- and post-operative data. There was no significant difference between the two groups in terms of age (P = 0.11), gender distribution (P = 0.32), body mass index (P = 0.43), preoperative hemoglobin (P = 0.34), and preoperative estimated glomerular filtration rate (eGFR; P = 0.64). One patient in the embolization group required radical nephrectomy because of accidental backflow of glue into the renal artery during embolization whereas four patients required clamping due to inadequate embolization. Preoperative super-selective embolization yielded significantly less blood loss, compared to "on-clamp" LPN (145 [50.76 mL] vs. 261 [66.12 mL], P < 0.01). There was no significant difference between post-operative eGFR (at 1 month) between the two groups (P = 0.71). Preoperative embolization offers improved outcomes in the dissection plane, total operative time, and blood loss, compared to conventional "on-clamp" LPN but has no significant effect on change in eGFR. [ABSTRACT FROM AUTHOR]

Highlight: • Preoperative tumor embolization was performed to reduce intraoperative risk and maximize resection success • Endovascular embolization has developed into an important and effective adjuvant in tumor management before a surgical resection. ABSTRACT Introduction: Hypervascular tumors of the head, neck, and central nervous system are associated with a high risk of bleeding during surgery. Hemangioma is a benign neoplasm that tends to grow rapidly, bleed, and have a high recurrence rate, especially after partial resection. Considering that hemangioma is a type of tumor with high vascularity, preoperative tumor embolization was performed to reduce intraoperative risk and maximize resection success. Case: A 33-year-old female came with the chief complaint of chronic progressive headaches and vision loss in the last 5 years. She got a lump on her forehead and had a visual acuity of 1/∞ in both eyes. She had already been diagnosed with hemangioma at a secondary regional hospital, where she bled profusely on the operating table, causing the resection to be discontinued. She was referred to our hospital for preoperative embolization. She underwent an endovascular embolization procedure with PVA particles to seal the feeder artery to the tumor. After embolization, angiography showed a complete devascularized tumor lesion. A total resection was done three days later with minimal bleeding compared to the first surgery. After a three-month follow-up, there was no new neurological deficit, and her headache was resolved completely, although her vision still did not improve. Conclusion: Endovascular embolization has developed into an important and effective adjuvant in tumor management before a surgical resection. Advances in catheter-based techniques, in conjunction with the development of the neurointervention field, are expected to raise the number of perioperative embolization procedures performed.

Juvenile nasopharyngeal angiofibroma (JNA) is a histopathologically benign and highly vascular neoplasm of the nasopharynx. Surgery is the treatment of choice for this type of tumor, but its highly vascular nature could result in profuse and uncontrollable bleeding. Preoperative transcatheter arterial embolization offers an effective and minimally invasive modality for reducing intraoperative blood loss. We report 2 cases of JNA in a 17-year-old male and 14-year-old male who underwent preoperative embolization of external carotid artery branch using gelatin sponge slury and polyvinyl alcohol. Even without internal carotid artery branch embolization, both of our reported cases had intraoperative blood loss of 1100 mL and 1300 mL which are less than the previously reported mean blood loss of 1428 mL in patients who underwent both internal and external carotid artery branch embolization.

Abstract Background Surgical resection plays a critical role in the curative therapy of patients with gallbladder cancer. However, extended resection for locally advanced gallbladder cancer is a controversial procedure because of the high operative morbidity, mortality, and poor prognosis after surgery, without consensus of its suitability. Several reports have described preoperative treatment modalities to reduce the risk of mortality and morbidity and improve the curability of surgery for locally advanced GBCA. However, only a few well-designed studies have verified the benefits of these preoperative strategies. Case presentation A 62-year-old male patient presented to our department with a gallbladder tumor detected on abdominal ultrasound during an annual medical checkup. Multi-phase enhanced CT revealed a gallbladder tumor with a maximum diameter of 34 mm, invading the right hepatic artery, pancreatic head, hepatic flexure of the colon, and first portion of the duodenum. We diagnosed gallbladder carcinoma as cT4 cN0 cM0 cStage IVA in the Union for International Cancer Control (UICC) classification 8th edition. After administration of 12 cycles of gemcitabine and cisplatin plus S-1 regimen, tumor shrinkage was observed on computed tomography, and elevated serum CA19-9 levels were reduced to normal limits. After preoperative hepatic artery embolization, we performed gallbladder bed resection with pancreaticoduodenectomy (minor hepatopancreatoduodenectomy) and combined resection of the right hepatic artery and hepatic flexure of the colon. Histological examination revealed no evidence of lymph node metastasis (ypT4 ypN0 ycM0 yp Stage IVA in the 8th edition of the UICC). The proximal bile duct and dissected margins were negative. Conclusions The combination of induction chemotherapy and preoperative hepatic artery embolization, followed by minor hepatopancreatoduodenectomy and combined resection of the involved arteries and partial colon, could be a feasible treatment strategy for patients with locally advanced gallbladder cancer invading neighboring organs.

Background: Surgical resection plays a critical role in the curative therapy of patients with gallbladder cancer. However, extended resection for locally advanced gallbladder cancer is a controversial procedure because of the high operative morbidity, mortality, and poor prognosis after surgery, without consensus of its suitability. Several reports have described preoperative treatment modalities to reduce the risk of mortality and morbidity and improve the curability of surgery for locally advanced GBCA. However, only a few well-designed studies have verified the benefits of these preoperative strategies. Case presentation: A 62-year-old male patient presented to our department with a gallbladder tumor detected on abdominal ultrasound during an annual medical checkup. Multi-phase enhanced CT revealed a gallbladder tumor with a maximum diameter of 34 mm, invading the right hepatic artery, pancreatic head, hepatic flexure of the colon, and first portion of the duodenum. We diagnosed gallbladder carcinoma as cT4 cN0 cM0 cStage IVA in the Union for International Cancer Control (UICC) classification 8th edition. After administration of 12 cycles of gemcitabine and cisplatin plus S-1 regimen, tumor shrinkage was observed on computed tomography, and elevated serum CA19-9 levels were reduced to normal limits. After preoperative hepatic artery embolization, we performed gallbladder bed resection with pancreaticoduodenectomy (minor hepatopancreatoduodenectomy) and combined resection of the right hepatic artery and hepatic flexure of the colon. Histological examination revealed no evidence of lymph node metastasis (ypT4 ypN0 ycM0 yp Stage IVA in the 8th edition of the UICC). The proximal bile duct and dissected margins were negative. Conclusions: The combination of induction chemotherapy and preoperative hepatic artery embolization, followed by minor hepatopancreatoduodenectomy and combined resection of the involved arteries and partial colon, could be a feasible treatment strategy for patients with locally advanced gallbladder cancer invading neighboring organs. [ABSTRACT FROM AUTHOR]

Purpose: Observation is the first management option in asymptomatic meningiomas, but when an enlargement or mass effect is observed, surgery is indicated. This study is aimed at exploring risk factors for complications and recurrence after surgery for asymptomatic meningioma. We also examined the impact of preoperative tumor embolization, which is considered controversial. Methods: We retrospectively reviewed 109 patients with primary asymptomatic meningiomas surgically treated at our institute between April 2007 and March 2021. Patients who only had headaches as a nonspecific complaint were included in the asymptomatic group. Complications, time to recurrence, and Glasgow Outcome Scale (GOS) score were the endpoints of the study. Risk factors for complications and recurrence were explored. Moreover, the effect of the resection on nonspecific headaches was also explored. Results: The permanent postoperative complication rate related to the surgical procedure was 1.8%. Of the total, 107 patients (98.2%) with asymptomatic meningiomas who were surgically treated achieved a GOS score of 5 1 year after the operation. Preoperative headache was present in 31 patients and improved postoperatively in 21 patients. Multivariate analysis using the Cox proportional hazard model showed that preoperative tumor embolization with > 80% resolution of tumor staining (p < 0.001) was negatively related to recurrence, whereas age (p = 0.046) and Simpson grade IV resection (p = 0.041) were positively related to recurrence. Conclusion: Although surgery for asymptomatic meningiomas can, in many cases, be safe, it is not free of complications Thus, surgical intervention for asymptomatic meningiomas should be considered cautiously. However, more than half the patients with headaches showed improvement. Simpson grade IV resection cases should be assessed for recurrence, and preoperative tumor embolization might be effective in controlling recurrence. [ABSTRACT FROM AUTHOR]

There is no definitive consensus on the impact of preoperative embolization on carotid body tumor (CBT) treatment. The objective of this study was to compare surgical outcomes of patients who underwent preoperative embolization before CBT resection vs patients who underwent resection alone. The CAPACITY registry included 1432 patients with CBT from 11 medical centers in four different countries. The group of patients undergoing CBT resection with preoperative embolization was matched in a 1:6 ratio from a pool of patients from the CAPACITY database, using a generated propensity score with patients who did not underwent preoperative embolization. A total of 553 patients were included for analysis. Mean patient age was 56.23 ± 12.22 years. Patients were mostly female (n = 469; 84.8%). Bilateral CBT was registered in 60 patients (10.8%). Seventy-nine patients (14.3%) underwent preoperative embolization. Embolized patients had larger CBT sizes than non-embolized patients (33.8 mm vs 18.4 mm; P =.0001). Operative blood loss was lower in the embolized group compared with the non-embolized group (200 mL vs 250 mL; P =.031). Hematomas were more frequent in the non-embolized group (0% vs 2.7%; P =.044). Operative time, rates of stroke, cranial nerve injuries, and death were not statistically significant between groups. Embolization before CBT resection was associated with significantly lower blood loss and lower neck hematomas than patients who underwent resection alone. Operative time, stroke, cranial nerve injuries, and death were similar between groups. [ABSTRACT FROM AUTHOR]

Background: Carotid body tumor (CBT) is the most common head and neck paraganglioma. Whether preoperative embolization benefits CBT patients who will receive surgical resection is still controversial. Methods: In this multi-center retrospective study, we collected data from patients with CBT who received surgical treatment without (group A) or with preoperative embolization (group B) from 2011 to 2019. The primary outcome was the rate of death or stroke after 3 years of follow-up. The secondary outcomes of the study were length of operation (LOO), intraoperative blood loss (IBL), length of stay (LOS), rate of recurrence, and rate of cranial nerve (CN) injuries. Descriptive statistics were used to analyze the demographics, clinical characteristics, complications, and follow-up results of the patients. Results: Between January 2011 and October 2019, 261 consecutive patients (107 male and 154 female) entered analysis. After 3 years of follow-up, no patient died in both groups. Only three patients with stroke were detected: 2/226 (0.9%) in group A vs. 1/35 (2.9%) in group B (p = .308). The LOO in group A was 132.6 ± 64.6 min compared with 152.9 ± 40.4 min in group B (p = .072). IBL in group A was 375.4 ± 497.8 ml compared with 448.0 ± 270.8 ml in group B (p = .400). LOS in group A was 8.3 ± 2.0 days compared with 7.4 ± 1.7 days in group B (p = .016). Seventy-two CN injuries were detected: 65/226 (28.8%) in group A vs. 7/35 (20.0%) in group B (p = .281). There were 65 temporary CN injuries (59 in group A vs. 6 in group B) (p = .254) and seven permanent CN injuries (6 in group A vs. 1 in group B) (p = .945). Three most frequently injured cranial nerves were the pharyngeal branch and superior laryngeal nerve (12.3%), recurrent laryngeal nerve (7.7%) and vagus nerve (7.3%). Conclusion: There was insufficient evidence to support the efficacy of preoperative embolization. CBT resection alone had a similar rate of stoke, recurrence, and CN injuries when compared with CBT resection with preoperative arterial embolization. Meanwhile, CBT resection alone did not increase LOO and IBL. [ABSTRACT FROM AUTHOR]

Introduction: This study investigated the efficacy and complications of preoperative embolization for spinal metastatic tumors, focusing on the etiology of post-embolization paralysis. Methods: We retrospectively reviewed the data of 44 consecutive patients with spinal metastases treated between September 2012 and December 2020. Intraoperative blood loss and postoperative transfusion requirement were compared between the embolization (+) and (−) groups. Complications associated with embolization were reviewed. Results: Overall, 30 patients (68%) underwent preoperative embolization. All the patients in both groups underwent palliative posterior decompression and fusion. The mean intraoperative blood loss in the overall population was 359 ml (range, minimum-2190 ml) and was 401 ml and 267 ml in the embolization (+) and embolization (−) groups, respectively. Four patients (9%) (2 patients from each group) required blood transfusion. There were no significant between-group differences in blood loss and blood transfusion requirements. All 7 patients with hypervascular tumors were in the embolization (+) group. Two patients experienced muscle weakness in the lower extremities on days 1 and 3 after embolization. There were metastases in T5 and T1-2, and magnetic resonance imaging after embolization showed slight exacerbation of spinal cord compression. The patients showed partial recovery after surgery. Conclusions: With the predominance of hypervascular tumors in the embolization (+) group, preoperative embolization may positively affect intraoperative bleeding. Embolization of metastatic spinal tumors may pose a risk of paralysis. Although the cause of paralysis remains unclear, it might be due to the aggravation of spinal cord compression. Considering this risk of paralysis, we advocate performing surgery as soon as possible after embolization.

Purpose: The purpose of the study was to assess the effectiveness and safety of preoperative embolization in the treatment of patients with metastatic epidural spinal cord compression (MESCC). Methods: A retrospective analysis of 138 MESCC patients who underwent decompressive surgery and spine stabilization was performed in a large teaching hospital. Among all enrolled patients, 46 patients were treated with preoperative embolization (the embolization group), whereas 92 patients did not (the control group). Patient’s baseline clinical characteristics, surgeryrelated characteristics, and postoperative neurological status, complications, and survival prognoses were collected and analyzed. Subgroup analysis was performed according to the degree of tumor vascularity between patients with and without preoperative embolization. Results: Patients with severe hypervascularity experienced more mean blood loss in the control group than in the embolization group, and this difference was statistically significant (P=0.02). The number of transfused packed red cells (PRC) showed a similar trend (P=0.01). However, for patients with mild and moderate hypervascularity, both blood loss and the number of PRC transfusion were comparable across the two groups. Regarding decompressive techniques, the embolization group (64.29%, 9/14) had a higher proportion of circumferential decompression in comparison to the control group (30.00%, 9/30) among patients with severe hypervascularity (P=0.03), whereas the rates were similar among patients with mild (P=0.45) and moderate (P=0.54) hypervascularity. In addition, no subgroup analysis revealed any statistically significant differences in operation time, postoperative functional recovery, postoperative complications, or survival outcome. Multivariate analysis showed that higher tumor vascularity (OR[odds ratio]=3.69, 95% CI [confident interval]: 1.30-10.43, P=0.01) and smaller extent of embolization (OR=4.16, 95% CI: 1.10- 15.74, P=0.04) were significantly associated with more blood loss. Conclusions: Preoperative embolization is an effective and safe method in treating MESCC patients with severe hypervascular tumors in terms of intraoperative blood loss and surgical removal of metastatic tumors. Preoperative tumor vascularity and extent of embolization are independent risk factors for blood loss during surgery. This study implies that MESCC patients with severe hypervascular tumors should be advised to undergo preoperative embolization. [ABSTRACT FROM AUTHOR]

Organized hematoma (OH) is benign tumor in the maxillary sinus. The standard treatment for OH is complete surgical resection, however massive bleeding can occur during the procedure, albeit rarely. Some reports have suggested preoperative embolization is useful for reducing the volume of intraoperative bleeding. We report 3 cases of OH in the maxillary performed preoperative embolization. We identified the feeding arteries by angiography or IVR-CT, and we embolized them using Gelatin sponge particles. The embolized artery was the maxillary artery or both the maxillary and the facial artery. There were no major complications as a result of embolization. The mean fluoroscopy time was 35.8 minutes, and the mean fluoroscopy dose was 329.3 mGy. Tumor resection was performed the next day after arterial embolization. The mean bleeding volume for surgery was 383.3 ml, and the mean operative time was 194 minutes. No recurrence was observed in any of the cases over a 4-year follow-up period. We considered that it is possible that preoperative artery embolization is useful for decreasing intraoperative bleeding volume. Although the methods and usefulness of embolization await future reports, it is a technique that should be considered preoperatively because of its potential to prevent massive bleeding.

Introduction: Preoperative embolization (PE) for spinal metastasis can be used to reduce tumor blood supply in selected patients. The decision whether and when to perform PE varies largely among spine surgeons and centers. Research question: The aim was to understand the current decision-making process in European spine centers. Material and methods: The European Association of Neurosurgical Societies (EANS) spine section designed a 13-item online survey. It was distributed to neurosurgical residents and board-certified neurosurgeons between 7th of February and May 5, 2023. Results: We analyzed 120 survey responses. Most participants were board-certified neurosurgeons (71%) or residents (26%) in university hospitals (76%). Routinely performed PE was stated not a common practice in 62%. Of those using PE, 25% indicated to perform it in selected cases requiring vertebral body replacement. Reasons for not performing PE included lack of time (44%), unclear benefits (25%), no significant bleeding without PE (19%), and significant bleeding despite PE (8%). Most participants opted for PE

Introduction: Preoperative embolization for metastatic spinal cord compression (MSCC) has a risk of spinal ischemia. This study aimed to assess the efficacy and safety of preoperative embolization in patients with MSCC and evaluate the use of computed tomography (CT) angiography for the detection of the radiculomedullary arteries (RMA). Methods: This retrospective study included 20 patients (12 men and 8 women; median age, 66 years), who underwent preoperative embolization before a decompression surgery, which corresponded to 22 embolization procedures. The detection ability of RMA was evaluated using angiography and selective CT angiography. Surgical data including intraoperative blood loss and transfusion were also evaluated. Results: Six RMAs were identified at the levels of affected vertebrae and one level above and below in the diagnostic spinal angiography. In addition to spinal angiography, adjunctive selective CT angiography allowed visualization of another five RMAs. Overall, 11 RMAs were identified in 9 patients. Preoperative embolization was successfully achieved in all patients. As regards complications related to embolization procedure, palsy exacerbated in one patient (4.5%), which improved postoperatively. During the surgical procedure, the mean intraoperative blood loss was 353.4±254.2 mL without intraoperative transfusion in all patients. Conclusions: The present study showed small amounts of intraoperative blood loss without any severe complications related to preoperative embolization. Selective CT angiography was a useful technique to detect RMAs and contributed to the safety of preoperative embolization.

Purpose: This study presented our 13-year experience managing patients with CBTs (carotid body tumors) and was aimed to investigate the impact of pre-TAE (preoperative transarterial embolization) on CBT surgical resection. Methods: This retrospective study reviewed 169 surgically excised CBTs between May 2007 and October 2020. According to whether to carry out the pre-TAE, the patients were classified into the embolization (EG) (n = 130) and non-embolization groups (NEG) (n = 39). Tumor classification was based on Shamblin criteria and tumor size. The demographic data, clinical features, and intraoperative and postoperative information about the patients were retrieved and analyzed. Results: The average tumor size was (43.49 vs. 35.44 mm, p = 0.04) for EG and NEG. The mean surgical time (195.48 vs. 205.64 mins, p = 0.62) and intraoperative BL (blood loss) (215.15 vs. 251.41 cc, p = 0.59) were less, but the incidence of revascularization required (29% vs. 33%, p = 0.62) and total complications (26% vs. 36%, p = 0.32) were lower in EG compared to NEG. Similarly, according to the subgroup analysis, no significant differences were detected in the surgical time, BL, adverse events (AEs), and the revascularization in EG when compared to NEG for type I (n = 5 vs. 7), II (n = 105 vs. 27), and III (n = 20 vs. 5), respectively except for the surgical duration in type III (p < 0.05). However, a significantly lower incidence of AEs (230.25 vs. 350 cc, p = 0.038) and a decline in BL (28.57% vs. 48.15%, p = 0.049) in EG were observed compared to those in NEG patients for large CBTs (≥ 30 mm as the cutoff point). No surgery-related mortality was observed during the follow-up. Conclusions: CBTs can be surgically resected safely and effectively with a need for pre-TAE, which significantly decreases the overall BL and AEs for large lesions (≥ 30 mm). [ABSTRACT FROM AUTHOR]

Intracranial angiomatous meningiomas are a rare WHO grade I histological variant of meningioma whose vascular component exceeds 50% of the total tumor area. Preoperative embolization of angiomatous meningiomas has rarely been reported previously. A 58-year-old woman was referred to our institute for a large petrotentorial hypervascular tumor presented with progressively worsening right facial paralysis and hearing loss for 6 months. Cranial computed tomography scan and magnetic resonance imaging revealed a large homogenously enhancing multilobulated mass involving middle and posterior cranial fossae with marked brainstem compression. The tumor extended into a right internal auditory canal and labyrinthine structures with destructive changes of bony structures. Magnetic resonance angiography showed hypervascularity in the tumor. Preoperative transarterial embolization using liquid embolic materials was successfully performed with resulting in almost complete devascularization of the tumor. Adequate hemostasis was achieved following gross total resection of the tumor (Simpson grade II). A histopathological examination confirmed the diagnosis of an angiomatous meningioma. Preoperative transarterial embolization of angiomatous meningioma with liquid embolic material was safe and effective in reducing perioperative blood loss and facilitating total tumor resection. [ABSTRACT FROM AUTHOR]

Abstract Background Symplastic hemangioma is a benign superficial abnormal buildup of blood vessels, with morphological features which can mimic a pseudo malignancy. A few cases have been reported in the literature. We report here, a unique case of calvarial symplastic hemangioma, which is the first case in the calvarial region. Case presentation A 29-year-old male patient, with a left occipital calvarial mass since childhood, that gradually increased in size with age, was associated with recurrent epileptic fits controlled by Levetiracetam (Keppra), with no history of trauma. He presented to the emergency room with a recent headache, vomiting, frequent epileptic fits and a decrease in the level of consciousness 1 day prior to admission. A CT scan showed three diploic, expansile, variable sized lytic lesions with a sunburst appearance; two that were biparietal, and one that was left occipital, which were all suggestive of calvarial hemangiomas. However, the large intracranial soft tissue content, within the hemorrhage of the occipital lesion was concerning. The patient had refused surgery over the years; however, after the last severe presentation, he finally agreed to treatment. The two adjacent, left parietal and occipital lesions were treated satisfactorily using preoperative embolization, surgical resection, and cranioplasty. Histopathology revealed cavernous hemangiomas, in addition to symplastic hemangioma (pseudo malignancy features) on top at the occipital lesion. The right parietal lesion was not within the surgical field; therefore, it was left untouched for follow-up. Conclusions Histopathology and radiology examinations confirmed the diagnosis as symplastic hemangioma, on top of a pre-existing cavernous hemangioma. To the best of our knowledge, this is the first case of a calvarial symplastic hemangioma, which we report here.

Purpose: This study was designed to investigate whether preoperative embolization is a useful procedure to decrease blood loss and neurovascular complications for carotid body tumor (CBT) surgery or not. Methods: Medical records of our tertiary care center from 2012 to 2019 were scanned for patients who underwent surgery for CBT, retrospectively. Age, gender, complaint and head and neck examination findings at the time of presentation, preoperative complete blood count parameters, imaging records (cervical magnetic resonance imaging and carotid artery angiography), Shamblin classification, tumor size, intraoperative findings, and postoperative complications were noted. Results: A total of 26 patients were operated due to CBT between 2012 and 2019 in our clinic; preoperative arterial embolization was performed to 15 (57.7%) patients, and 11 (42.3%) patients were operated without embolization. Youngest patient was 24 years old, while oldest was 69 years and mean age was 44.35 ± 12.73. (embolization group: ages ranging between 24 and 64 with a mean of 41.5 ± 11.02 years; in nonembolization group: ages ranging between 26 and 69 with a mean of 48.1 ± 14.3). Embolization status was not significantly related to cranial nerve injury, vascular injury, overall complications, and hematocrit decrease. Arterial injury is more likely to occur with increasing Shamblin class (r =.39; P =.04). Tumor size is not found to be significantly related to cranial nerve injury, vascular injury, overall complications, and hematocrit decrease, but cranial nerve injury and vascular injury were more likely to occur in large tumors (r =.34; P =.089 and r =.34; P =.087, respectively). Age was significantly and negatively correlated to vascular injury (r = −.51; P =.05). Vascular injury was significantly correlated with gender (male predominance: r = −.64; P =.000). Conclusion: Although preoperative arterial embolization is considered to attenuate the complication risk, we found that there was no significant difference among the patients with or without embolization. [ABSTRACT FROM AUTHOR]

The performance of preoperative embolization on a spinal tumor can be a useful adjunctive procedure that minimizes blood loss and complications, particularly for both metastatic and non-metastatic hypervascular tumors. We discuss two cases of hypervascular spinal tumors that were successfully treated with preoperative embolization and surgery. The first patient was an 18-year-old man who presented with cervical and shoulder pain for two months without paralysis or weakness. Magnetic resonance imaging revealed a tumor located in the D2 posterior vertebral arch that extended into the spinal canal and compressed the spinal cord. The second patient was a 68-year-old man with back pain that radiated to the legs for ten days. Magnetic resonance imaging revealed a mass in the L4 vertebral body. Both patients received tumor embolization and surgery. After surgery, neither patient experienced any major complications. Histological examination revealed osteoblastoma in the first patient and plasmacytoma in the second patient. [ABSTRACT FROM AUTHOR]

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.

Juvenile Nasopharyngeal Angiofibroma is a rare and locally aggressive benign tumor. It is characterized by high vascularization leading to spontaneous bleeding or massive hemorrhage. We reported a case of 13 years old boy with a swollen at the right face, nasal congestion, recurrent nose bleeding, hyposmia, headache, breathing difficulty, and a nasopharyngeal mass at CT scan. Angiography examination showed a highly vascularized mass which was successfully occluded through preoperative embolization procedures. It is suggested that imaging modalities is not only playing an important role in diagnostic process, but also as an adjunct treatment approach in patient with Juvenile Nasopharyngeal Angiofibroma.

A 25-year-old man with a venous malformation (VM) along the anterior and posterolateral aspects of the right chest wall presented with progressive enlargement of VM, chest wall pain, and physical disfigurement. Because of the complexity and size of the VM, a staged multidisciplinary team approach, ie percutaneous embolization, followed by surgical resection and tissue-skin grafting was used. The percutaneous embolization was achieved with a combination of liquid embolic agents including n-butyl cyanoacrylate for the superficial cutaneous component and ethylene vinyl alcohol copolymer for the deeper subcutaneous component of the VM. Such a combination can achieve safe occlusion of the VM, facilitate surgical resection without blood loss, and contribute to a cosmetically desirable result.

Herein, we present a clinical case of a successfully staged treatment for a patient with giant hypervascular extra-intracranial metastasis of locally advanced stage IVa T3bN1aM1 (skull) papillary thyroid cancer. To treat the patient, we used tactics that included preoperative endovascular embolization and total microsurgical metastasis removal with simultaneous cranioplasty using an individual stereolithographic titanium three-dimensional implant, followed by total thyroidectomy, radiotherapy, and pharmacotherapy (131I radioiodine and suppressive therapies).The patient was diagnosed with papillary cancer after total skull metastasis removal and obtaining path histological and immunohistochemical biopsy material analysis results.Giant hypervascular mass removal is associated with a high risk of intraoperative massive bleeding, unpredictable course of surgical intervention, and consequently, high probability of developing adverse postoperative complications.These cases are described in isolated reports, making this article relevant.The study describes a case when correctly planned tactics allowed operating the patient totally, safely, and with minimal blood loss and suggests the examination tactics in cranial hypervascular tumor patients.

BackgroundThis study aimed to investigate the clinicopathological characteristics of retroperitoneal solitary fibrous tumor (RSFT) and the safety of radical resection.MethodsA retrospective analysis was conducted on the data of 32 RSFT patients who received surgery with curative intent from February 2011 and June 2021.ResultsThis cohort included 16 (50%) male and 16 (50%) female patients, with the median age of 52 (29 to 72) years. Tumor burden ranged from 3 to 25 (median, 10) cm. Seven patients received arterial embolization before surgery. 15 (47%) patients received radiotherapy, nine (28%) of which received preoperative radiotherapy. Most of the patients (91%) achieved complete resection with median bleeding of 400 (20 to 5,000) ml. Nine (28%) patients received packed red blood cell (RBC) transfusion, with a median of 5 (2 to 10) U. All patients had the five-year progression-free survival rate and the overall survival rate of 75.8% and 80.0%, respectively. 11 (34%) patients were found with adverse events, and four (12%) patients were found with serious postoperative complications (Clavien-Dindo ≥3), of which one (3.1%) patient died after surgery. The univariate analysis found that tumor burden (p = 0.022), packed RBC transfusion (p = 0.001) and postoperative hospital stays (0.027) were correlated with overall morbidity. The multivariate analysis found packed RBC transfusion as an independent risk factor for postoperative morbidity (HR 381.652, 95% CI, 1.597–91213.029, p = 0.033).ConclusionRSFT was confirmed as an uncommon, slow-growing and recurring tumor, with acceptable postoperative morbidity and mortality after surgical resection.

Background: The pterygovaginal artery (PtVA), a recurrent branch of the internal maxillary artery (IMA), can be a feeder of skull base tumors. Preoperative embolization can help endoscopic resection of hypervascular lesions, which is performed under a narrow surgical space with restricted instrumental maneuverability. Methods: We performed preoperative embolization in five cases with hypervascular skull base lesions supplied by the PtVA, four of which were resected via endoscopic endonasal approach. In two cases, selective PtVA embolization through the distal IMA was successfully conducted. Results: In all the cases, intraoperative bleeding during endoscopic resection was easily controlled. The medial and lateral origins of the PtVA from the IMA were demonstrated by cone-beam CT images reconstructed from three-dimensional rotational angiography, and anastomoses around the eustachian tube and soft palate were visualized by superselective angiography. Conclusions: The PtVA embolization can be an effective strategy before endoscopic skull base tumor resection. When embolizing through the PtVA, clinicians should be aware of its anatomical variations and dangerous anastomoses. Understanding the surrounding angioarchitecture by angiographic techniques helps ensure safe embolization. [ABSTRACT FROM AUTHOR]

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.

Background: Jugular foramen paragangliomas (JFP) treatment represents a challenge for surgeons due to its close relationship with facial nerve (FN), lower cranial nerves (LCN), and internal carotid artery. Due to its hypervascularization, preoperative tumor embolization has been indicated. Methods: Retrospective analysis of the clinical evolution of 26 patients with JFP class C/D previously embolized treated through infratemporal/cervical access without FN transposition. Results: Total and subtotal resections were 50% each, regrowth/recurrence were 25%, and 23%, respectively, and mortality was 3.9%. Postoperatively, 68.4% of patients had FN House and Brackmann (HB) Grades I/II. New FN deficits were 15.4% post embolization and 30.7% postoperatively. Previous FN deficits worsened in 46.1%. Tumor involved the FN in 30.8% and in 62.5% of them these nerves were resected and grafted (60% of them had HB III). Lateral fall, ear murmur, and vertigo improved in all patients. Tinnitus improved in 77.8% and one patient developed tinnitus after surgery. Hearing loss did not improve, eight partial hearing loss remained unchanged and four worsened. New postoperative LCN deficits were 64.3%. Postoperative KPS between 80 and 100 dropped 8.3%. Two patients with secretory paragangliomas with arterial hypertension difficult to control had better postoperative blood pressure control. Conclusion: Although still with significant morbidity due to FN and LCN injuries, the treatment of patients with JFP Fisch C/D has good long-term results. Surgical techniques without FN transposition have less intraoperative nerve damage, lower rates of total resection, and higher recurrence. Preoperative embolization of JFP reduces the intraoperative blood loss but can cause FN deficit. [ABSTRACT FROM AUTHOR]

Objective – to increase the feasibility and safety of surgical treatment and to achieve better clinical outcome in patients with hypervascular spine tumors by combining managed endovascular embolization followed by surgery. Materials and methods. We enrolled 10 patients (6 men and 4 women, the average age was 57 years) with hypervascular spinal tumors who underwent examination and treatment at SO «Scientific-Practical Center of Endovascular Neuroradiology of NAMS of Ukraine» during the period from 2015 to 2019. Five patients have aggressive vertebral hemangiomas (L1, L2, Th12, Th 7, Th 6) and 5 patients have metastases of renal cell carcinoma of the vertebrae (Th4, Th10, Th12, L3) were included. Medical history and neurological status were evaluated, but in all cases the clinical diagnosis was made according to MRI and spine CT. In addition, all patients underwent selective spinal angiography via transfemoral access at the level of the lesion and in at least two adjacent levels. All patients underwent endovascular embolization of the tumor as the first step and open surgery in the volume of biopsy, decompression, and stabilization of the spine in the second stage. The volume of blood loss in ml was estimated by the anesthesiologist. Results. According to the localization of the lesions, spinal angiography showed a high accumulation of contrast fluid in its structure, compared to surrounding tissues, in all cases. This is evidence of the presence of a hypervascular lesion. All patients underwent the combination treatment – preventive endovascular embolization followed by surgery. In 9 cases embolization was performed 24–36 hours before surgery. Due to the patient’s somatic condition, open surgery was delayed once by 5 days. The total embolization of the tumor vasculature in 7 cases was achieved, with a subtotal embolization in 3 cases. Partial embolization was performed in one case of aggressive hemangioma when the afferent was involved in the blood supply of the spinal artery. Reversible deeper neurologic deficits following embolization in 4 cases was observed. Two patients noticed the reduction of the pain immediately after embolization. Mean intraoperative blood loss was 500 ml during the second stage of treatment. Blood loss was 600 ml in the case of delayed surgery. In all cases, the control of bleeding didn’t interrupt adequate decompression and transpedicular stabilization if it was required, and none of the surgical stages were delayed or canceled because of bleeding. Residual bleeding persisted from the venous system and tumor-related tissues. Conclusions. Preoperative embolization of hypervascularized tumors is a safe and effective method to reduce perioperative hemorrhage, which in turn leads to the reduction of the duration of surgery, improves the visualization of the surgical field, allows the performance of all steps of open surgery and achieve a positive clinical result. The mean blood loss was lower compared to procedures without preoperative embolization, according to published papers on surgery of hypervascular spinal tumors. Embolic agents (mixture of Histoacryl and Lipiodol and polyvinyl alcohol (PVA)) have shown high efficacy to control arterial bleeding, with residual bleeding from the venous system.

Laparoscopic adrenalectomy is regarded as a golden standard for surgical treatment of patients with adrenal pathology. Its advantages over the traditional surgery were shown by the experience and it explain commitment of surgeons to this method. However, implementation of this surgery is still discussible in some groups of the patients. Most relevant questions arouse about using laparoscopic technologies in patients with huge and malignant adrenal tumors. Objectively worse outcomes in these groups of patients and concerns about oncological results dictate need for future researches in this sphere. The article is devoted to the last achievements in adrenal surgery, connected with the implementation and wide spreading of laparoscopic operations. It covers most discussible in medical literature indications for such kind of surgery. Major attention is given to the modern concepts of indications and contraindications for laparoscopic procedures. A review of complications is done and we discuss ways of preventing them. Also, the article addresses to the role of endovascular embolization, in particular to the preoperative embolization, in complex treatment of patients with adrenal tumors.

Respiratory epithelial adenomatoid hamartomas (REAHs) are rare tumors occurring in the nasal cavity and sinuses, and their etiology is unknown. REAH is a relatively recently established lesion and is often misdiagnosed as nasal polyposis or other tumors. Preoperative endovascular embolization for sinonasal tumors is now widely accepted as an effective method to reduce blood loss, soften the tumor, and facilitate surgical procedures. However, to the best of our knowledge, there are no reports of the requirement for preoperative embolization in the management of REAH. Here, we present a 70-year-old man with an easily bleeding REAH of the olfactory cleft, vascularized by branches of the bilateral internal and external carotid arteries. We removed the tumor endoscopically after preoperative embolization of the bilateral sphenopalatine arteries. Histological investigation revealed an intratumoral hemorrhage accompanying the REAH, with no evidence of a residual or recurrent tumor during the last follow-up at 3 months. In conclusion, accurate preoperative diagnosis and proper preoperative interventions such as embolization are needed for safe and adequate treatment of REAHs that have an abundant blood flow. [ABSTRACT FROM AUTHOR]

BackgroundThe role of preoperative embolization (PE) in reducing intraoperative blood loss (IBL) during surgical treatment of spinal metastases remains controversial.MethodsA systematic search was conducted for retrospective studies and randomized controlled trials (RCTs) comparing the IBL between an embolization group (EG) and non-embolization group (NEG) for spinal metastases. IBL data of both groups were synthesized and analyzed for all tumor types, hypervascular tumor types, and non-hypervascular tumor types.ResultsIn total, 839 patients in 11 studies (one RCT and 10 retrospective studies) were included in the analysis. For all tumor types, the average IBL did not differ significantly between the EG and NEG in the RCT (P = 0.270), and there was no significant difference between the two groups in the retrospective studies (P = 0.05, standardized mean difference [SMD] = −0.51, 95% confidence interval [CI]: −1.03 to 0.00). For hypervascular tumors determined as such by consensus (n = 542), there was no significant difference between the two groups (P = 0.52, SMD = −0.25, 95% CI: −1.01 to 0.52). For those determined as such using angiographic evidence, the IBL was significantly lower in the EG than in the NEG group, in the RCT (P = 0.041) and in the retrospective studies (P = 0.004, SMD = −0.93, 95% CI: −1.55 to −.30). For IBL of non-hypervascular tumor types, both the retrospective study (P = 0.215) and RCT (P = 0.947) demonstrated no statistically significant differences in IBL between the groups.ConclusionsOnly tumors angiographically identified as hypervascular exhibited lower IBL upon PE in this study. Further exploration of non-invasive methods to identify the vascularity of tumors is warranted.

There is a paucity of data regarding their surgical management and outcomes. Here, we reported a case involving an aggressive cervical VH, discussed its surgical management and outcomes, and reviewed the literature. Methods: We assessed the clinical, radiological, and surgical outcomes for a patient with an aggressive cervical VH. We also performed a systematic review of the literature according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to describe surgical outcomes for symptomatic VH. Results: A total of 154 studies including 535 patients with VH were included in the study. The majority of patients were female (62.8%), the average age was 43 years, and the thoracic spine was most commonly involved (80.6%). Utilizing Odom's criteria, outcomes were excellent in 81.7% (95% CI 73.2-90.2) of cases. For those presenting with myelopathy (P = 0.045) or focal neurological deficits (P = 0.018), outcomes were less likely to be excellent. Preoperative embolization was not associated with excellent outcome (P = 0.328). Conclusion: Surgical outcomes for VH are predominantly favorable, but aggressive VHs have the potential to cause significant residual postoperative neurological morbidity. [ABSTRACT FROM AUTHOR]

Background: Symplastic hemangioma is a benign superficial abnormal buildup of blood vessels, with morphological features which can mimic a pseudo malignancy. A few cases have been reported in the literature. We report here, a unique case of calvarial symplastic hemangioma, which is the first case in the calvarial region.Case Presentation: A 29-year-old male patient, with a left occipital calvarial mass since childhood, that gradually increased in size with age, was associated with recurrent epileptic fits controlled by Levetiracetam (Keppra), with no history of trauma. He presented to the emergency room with a recent headache, vomiting, frequent epileptic fits and a decrease in the level of consciousness 1 day prior to admission. A CT scan showed three diploic, expansile, variable sized lytic lesions with a sunburst appearance; two that were biparietal, and one that was left occipital, which were all suggestive of calvarial hemangiomas. However, the large intracranial soft tissue content, within the hemorrhage of the occipital lesion was concerning. The patient had refused surgery over the years; however, after the last severe presentation, he finally agreed to treatment. The two adjacent, left parietal and occipital lesions were treated satisfactorily using preoperative embolization, surgical resection, and cranioplasty. Histopathology revealed cavernous hemangiomas, in addition to symplastic hemangioma (pseudo malignancy features) on top at the occipital lesion. The right parietal lesion was not within the surgical field; therefore, it was left untouched for follow-up.Conclusions: Histopathology and radiology examinations confirmed the diagnosis as symplastic hemangioma, on top of a pre-existing cavernous hemangioma. To the best of our knowledge, this is the first case of a calvarial symplastic hemangioma, which we report here. [ABSTRACT FROM AUTHOR]

Background: The role of preoperative embolization (PE) in reducing intraoperative blood loss (IBL) during surgical treatment of spinal metastases remains controversial. Methods: A systematic search was conducted for retrospective studies and randomized controlled trials (RCTs) comparing the IBL between an embolization group (EG) and non-embolization group (NEG) for spinal metastases. IBL data of both groups were synthesized and analyzed for all tumor types, hypervascular tumor types, and non-hypervascular tumor types. Results: In total, 839 patients in 11 studies (one RCT and 10 retrospective studies) were included in the analysis. For all tumor types, the average IBL did not differ significantly between the EG and NEG in the RCT (P = 0.270), and there was no significant difference between the two groups in the retrospective studies (P = 0.05, standardized mean difference [SMD] = −0.51, 95% confidence interval [CI]: −1.03 to 0.00). For hypervascular tumors determined as such by consensus (n = 542), there was no significant difference between the two groups (P = 0.52, SMD = −0.25, 95% CI: −1.01 to 0.52). For those determined as such using angiographic evidence, the IBL was significantly lower in the EG than in the NEG group, in the RCT (P = 0.041) and in the retrospective studies (P = 0.004, SMD = −0.93, 95% CI: −1.55 to −.30). For IBL of non-hypervascular tumor types, both the retrospective study (P = 0.215) and RCT (P = 0.947) demonstrated no statistically significant differences in IBL between the groups. Conclusions: Only tumors angiographically identified as hypervascular exhibited lower IBL upon PE in this study. Further exploration of non-invasive methods to identify the vascularity of tumors is warranted. [ABSTRACT FROM AUTHOR]

• Hemangiomas are common benign vascular tumors of the head and neck region. However, they are not common to arise in the sinonasal mucosa. • Hemangioms have an average size of one centimeter and have been reported to be as large as 8 cm. • The endoscopic approach is the usual surgical approach in small size hemangiomas, while an open approach is more common with the larger size. • Preoperative embolization has been shown to be effective in decreasing tumor size and minimizing bleeding. Hemangiomas are common vascular benign tumors of the head and neck region. However, it is uncommon for them to arise in the paranasal sinus mucosal tissues. Paranasal sinus hemangiomas have nonspecific characteristics clinically and radiologically, even though it has to be considered as a differential diagnosis to avoid the misdiagnosis of sequalae. We present a case of a 37 year-old female diagnosed with a paranasal large size hemangioma treated with functional endoscopic sinus surgery (FESS). The case had a rare anatomical location of the hemangioma, along with a minimally invasive approach for a large size hemangioma. Owing to that fact, it might be challenging to differentiate between paranasal sinus hemangiomas and other benign or malignant pathologies. While paranasal sinus hemangiomas occur rarely, they have arisen from the paranasal sinus mucosa. They have an average size of 1 cm, and have been reported to be as large as 8 cm, similarly to this case. When larger in size, hemangioma resections are usually approached through open surgery, whereas, in this case, the hemangioma was resected completely by FESS. [ABSTRACT FROM AUTHOR]

Type 2 endoleaks are a potential complication of endovascular aortic repair for abdominal aortic aneurysms. They are caused by vessels that have been excluded from the aorta lumen, but may still fill the aneurysm sac due to collateral filling. Type 2 endoleaks may lead to increased morbidity and need for additional procedures. Being able to identify patients at risk for Type 2 endoleaks and prevent them is important for any physician who is performing endovascular aortic repair. [ABSTRACT FROM AUTHOR]

Endovascular embolization or embosurgery of brain tumors can be used to reduce neoplasm vascularity prior to surgical resection. Two challenges with embosurgery relate to insufficient perfusion pressure into the tumor and inadvertent escape of infused agents into parenchymal branches of the adjacent brain. This report describes a multi-catheter and coil technique to improve tumor perfusion and prevent reflux into normal branches.

Risk of massive intraoperative hemorrhage and the difficulty to control it makes the laparoscopic treatment of giant hepatic hemangiomas (GH) a challenge for minimally invasive hepatobiliary surgeons. Symptomatic GHs of more than 20 cm (extremely giant hepatic hemangiomas) are typically treated with an open resection. There is a paucity of literature on laparoscopic resection of extremely giant hepatic hemangiomas. We describe (with video), here, the technical nuances of pure laparoscopic resection of an extremely giant hepatic hemangioma using modified port positions and the anterior approach.

Giant cell tumors (GCTs) of the bone present unique challenges in management due to their locally aggressive nature and potential for recurrence. This case report describes the successful surgical management of a GCT located in the proximal tibia of a 28-year-old female. The patient presented with six months of pain and swelling following a traumatic injury to the knee. Diagnostic imaging confirmed the presence of a GCT, leading to preoperative prophylactic embolization to reduce intraoperative bleeding. Surgical excision of the tumor was performed, followed by reconstruction using autologous fibula grafts and plate fixation. Postoperative care included analgesia, antibiotics, and physiotherapy. Regular follow-up demonstrated satisfactory clinical outcomes without evidence of recurrence. This case highlights the importance of a multidisciplinary approach combining surgical expertise, preoperative planning, and postoperative rehabilitation to achieve favorable outcomes in managing GCTs., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Gharpinde et al.)

Around 40% of cancer patients present with spinal metastases (SM), the lumbar spine being the second most involved site (15%-30%) after the thoracic (60%-80%). Since the development of separation surgery, minimally invasive surgery (MIS) has increasingly been applied to approach SM, mirroring benefits yielded in the degenerative realm. Moreover, preoperative embolization potentially enhances local control for certain radioresistant histologies. Carbon fiber-reinforced PEEK hardware reduces image artifact, facilitating more accurate follow-up and radiotherapeutic planning. Additionally, short-segment cement-augmented constructs may be beneficial to decrease surgical morbidity and operative risk in this population. The authors present a lumbar spinal metastasis treated with MIS techniques. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23222., Competing Interests: Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this publication.The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this publication., (© 2024, The Authors.)