Preoperative embolization of hypervascular pediatric brain tumors: Evaluation of technical safety and outcome

Background: Surgical management of pediatric hypervascular brain tumors is challenging because of the risk of bleeding. We sought to evaluate the technical factors associated with safety and outcome of preoperative embolization of pediatric hypervascular brain tumors. Materials and methods: Eight pediatric brain tumor patients received preoperative endovascular embolization during the past 8 years. The cases included four choroid plexus papillomas, one yolk sac tumor, one intraventricular meningioma, one astrocytoma, and one hemangioblastoma. Embolization was done by superselection of the feeding arteries with microcatheters followed by slow injection of either n-butyl 2-cyanoacrylate (NBCA) or tris-acryl gelatin microspheres (Embosphere). Surgery for tumor removal was done in the same session right after embolization in all but one patient. Blood loss during surgery and clinical outcome were recorded. Results: Preoperative embolization was successfully done in all patients. Technical complication was noted in two patients. One patient developed bleeding while embolizing the tumor with Embospheres but was immediately embolized with NBCA without sequel. The other patient experienced tumor bleeding 4 h after embolization with Embospheres, and suffered left hemiparesis despite an emergency surgery. Surgical intervention was successfully done in all patients without procedure-related complication. Surgical blood loss ranged from 50 to 1,600 ml. Conclusion: Though associated with the risk of procedure-related bleeding, preoperative embolization of pediatric hypervascular brain tumors has high technical success rates and can enhance the surgical management. We suggest to perform the embolization and surgery in a single session and to use NBCA as the embolic agent to minimize the procedure-related risk.