Preoperative embolization of intracranial hemangiopericytomas: Case series and introduction of the transtumoral embolization technique

Brian W. Hanak, Diogo C. Haussen, Sudheer Ambekar, Manuel Ferreira, Basavaraj V. Ghodke, Eric Peterson

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background and purpose Hemangiopericytomas (HPCs) are rare dural-based neoplasms. Preoperative embolization of these notoriously hypervascular tumors can be challenging as they often receive their dominant blood supply from pial feeders arising from the internal carotid artery (ICA) or vertebrobasilar (VB) circulation. This study reviews our historical experience with HPC embolization and introduces the transtumoral technique for backfilling pial tumor vasculature by delivering Onyx- 18 through diminutive external carotid artery (ECA) feeders. Methods A retrospective review of all preoperative HPC embolizations performed at Anonymous University #1 (September 2002?November 2014) and Anonymous University #2 ( January 2014?November 2014) is presented. Results Fifteen patients with pathologically confirmed HPC underwent 17 embolizations. More extensive devascularization percentages were achieved for HPCs with primarily ECA blood supply (76.4?10.7%; n=6) than with HPCs supplied via the ICA/VB circulation (57.9 ?26.9%; n=8; p=0.046). There was a trend towards greater devascularization of ICA/VB-dominant HPCs embolized with Onyx (70.0?34.6%; n=4) versus polyvinyl alcohol particles (33.3?15.3%; n=3). The extent of angiographic devascularization negatively correlated with intraoperative blood loss (rho=-0.71; p=0.005). There were no embolization-related complications. Conclusions The extent of preoperative embolization of HPCs correlates with decreased intraoperative blood loss. However, HPCs with an ICA/VB-dominant blood supply remain challenging embolization targets, demonstrating reduced devascularization percentages compared with ECA-dominant counterparts. The authors favor the use of Onyx for ICA/VB-dominant HPCs, noting a trend towards an improved devascularization rate.

Original languageEnglish (US)
Pages (from-to)1084-1094
Number of pages11
JournalJournal of NeuroInterventional Surgery
Volume8
Issue number10
DOIs
StatePublished - Oct 1 2016

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Hemangiopericytoma
Internal Carotid Artery
External Carotid Artery
Polyvinyl Alcohol
Neoplasms

Keywords

  • Angiography
  • Liquid Embolic Material
  • Neoplasm
  • Technique
  • Tumor

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Preoperative embolization of intracranial hemangiopericytomas : Case series and introduction of the transtumoral embolization technique. / Hanak, Brian W.; Haussen, Diogo C.; Ambekar, Sudheer; Ferreira, Manuel; Ghodke, Basavaraj V.; Peterson, Eric.

In: Journal of NeuroInterventional Surgery, Vol. 8, No. 10, 01.10.2016, p. 1084-1094.

Research output: Contribution to journalArticle

Hanak, Brian W. ; Haussen, Diogo C. ; Ambekar, Sudheer ; Ferreira, Manuel ; Ghodke, Basavaraj V. ; Peterson, Eric. / Preoperative embolization of intracranial hemangiopericytomas : Case series and introduction of the transtumoral embolization technique. In: Journal of NeuroInterventional Surgery. 2016 ; Vol. 8, No. 10. pp. 1084-1094.
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title = "Preoperative embolization of intracranial hemangiopericytomas: Case series and introduction of the transtumoral embolization technique",
abstract = "Background and purpose Hemangiopericytomas (HPCs) are rare dural-based neoplasms. Preoperative embolization of these notoriously hypervascular tumors can be challenging as they often receive their dominant blood supply from pial feeders arising from the internal carotid artery (ICA) or vertebrobasilar (VB) circulation. This study reviews our historical experience with HPC embolization and introduces the transtumoral technique for backfilling pial tumor vasculature by delivering Onyx- 18 through diminutive external carotid artery (ECA) feeders. Methods A retrospective review of all preoperative HPC embolizations performed at Anonymous University #1 (September 2002?November 2014) and Anonymous University #2 ( January 2014?November 2014) is presented. Results Fifteen patients with pathologically confirmed HPC underwent 17 embolizations. More extensive devascularization percentages were achieved for HPCs with primarily ECA blood supply (76.4?10.7{\%}; n=6) than with HPCs supplied via the ICA/VB circulation (57.9 ?26.9{\%}; n=8; p=0.046). There was a trend towards greater devascularization of ICA/VB-dominant HPCs embolized with Onyx (70.0?34.6{\%}; n=4) versus polyvinyl alcohol particles (33.3?15.3{\%}; n=3). The extent of angiographic devascularization negatively correlated with intraoperative blood loss (rho=-0.71; p=0.005). There were no embolization-related complications. Conclusions The extent of preoperative embolization of HPCs correlates with decreased intraoperative blood loss. However, HPCs with an ICA/VB-dominant blood supply remain challenging embolization targets, demonstrating reduced devascularization percentages compared with ECA-dominant counterparts. The authors favor the use of Onyx for ICA/VB-dominant HPCs, noting a trend towards an improved devascularization rate.",
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AU - Hanak, Brian W.

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AU - Ferreira, Manuel

AU - Ghodke, Basavaraj V.

AU - Peterson, Eric

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N2 - Background and purpose Hemangiopericytomas (HPCs) are rare dural-based neoplasms. Preoperative embolization of these notoriously hypervascular tumors can be challenging as they often receive their dominant blood supply from pial feeders arising from the internal carotid artery (ICA) or vertebrobasilar (VB) circulation. This study reviews our historical experience with HPC embolization and introduces the transtumoral technique for backfilling pial tumor vasculature by delivering Onyx- 18 through diminutive external carotid artery (ECA) feeders. Methods A retrospective review of all preoperative HPC embolizations performed at Anonymous University #1 (September 2002?November 2014) and Anonymous University #2 ( January 2014?November 2014) is presented. Results Fifteen patients with pathologically confirmed HPC underwent 17 embolizations. More extensive devascularization percentages were achieved for HPCs with primarily ECA blood supply (76.4?10.7%; n=6) than with HPCs supplied via the ICA/VB circulation (57.9 ?26.9%; n=8; p=0.046). There was a trend towards greater devascularization of ICA/VB-dominant HPCs embolized with Onyx (70.0?34.6%; n=4) versus polyvinyl alcohol particles (33.3?15.3%; n=3). The extent of angiographic devascularization negatively correlated with intraoperative blood loss (rho=-0.71; p=0.005). There were no embolization-related complications. Conclusions The extent of preoperative embolization of HPCs correlates with decreased intraoperative blood loss. However, HPCs with an ICA/VB-dominant blood supply remain challenging embolization targets, demonstrating reduced devascularization percentages compared with ECA-dominant counterparts. The authors favor the use of Onyx for ICA/VB-dominant HPCs, noting a trend towards an improved devascularization rate.

AB - Background and purpose Hemangiopericytomas (HPCs) are rare dural-based neoplasms. Preoperative embolization of these notoriously hypervascular tumors can be challenging as they often receive their dominant blood supply from pial feeders arising from the internal carotid artery (ICA) or vertebrobasilar (VB) circulation. This study reviews our historical experience with HPC embolization and introduces the transtumoral technique for backfilling pial tumor vasculature by delivering Onyx- 18 through diminutive external carotid artery (ECA) feeders. Methods A retrospective review of all preoperative HPC embolizations performed at Anonymous University #1 (September 2002?November 2014) and Anonymous University #2 ( January 2014?November 2014) is presented. Results Fifteen patients with pathologically confirmed HPC underwent 17 embolizations. More extensive devascularization percentages were achieved for HPCs with primarily ECA blood supply (76.4?10.7%; n=6) than with HPCs supplied via the ICA/VB circulation (57.9 ?26.9%; n=8; p=0.046). There was a trend towards greater devascularization of ICA/VB-dominant HPCs embolized with Onyx (70.0?34.6%; n=4) versus polyvinyl alcohol particles (33.3?15.3%; n=3). The extent of angiographic devascularization negatively correlated with intraoperative blood loss (rho=-0.71; p=0.005). There were no embolization-related complications. Conclusions The extent of preoperative embolization of HPCs correlates with decreased intraoperative blood loss. However, HPCs with an ICA/VB-dominant blood supply remain challenging embolization targets, demonstrating reduced devascularization percentages compared with ECA-dominant counterparts. The authors favor the use of Onyx for ICA/VB-dominant HPCs, noting a trend towards an improved devascularization rate.

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