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Abstract
Introduction Preoperative embolisation for hypervascular tumours leads to decreased intraoperative bleeding, operative time, and improved patient morbidity. In an effort to delay glue precipitation and increase distal penetration we used 5% dextrose infusion in the guide catheter. We describe our experience with N-butyl cyanoacrylate (n-BCA)/Ethiodol mix, for preoperative brain tumour embolisation and for therapy for uncontrollable haemorrhagic head and neck tumours.
Materials/Methods A retrospective review of all patients who underwent brain, and head and neck tumour embolisation was performed from2007–2012. Patient who underwent n-BCA/Ethiodol embolisation with 5% dextrose guide catheter infusion were selected. N-BCA in Ethiodol concentrations used varies from 1:4–1:9. The concomitant use of dextrose infusion in the guide catheter allowed delay glue precipitation and distal tumour penetration (up to 180cc of dextrose infused during n-BCA embolisation). There were a total of 18 patients (19 embolisation sessions, 6 women, 12 men). Tumour type, location, endovascular and surgical treatment, percent of tumour embolisation, intraoperative tumour related bleeding, and complications were evaluated retrospectively.
Results There was total of 7 intracranial and 11 extra-cranial tumours. A total of 24 arteries were embolised, with at least 70% tumour embolisation achieved in all cases. There were no complications or patient morbidity related to the embolisation. No embolisation to normal intracranial vessels was encountered. N-BCA injection ranged from 30 sec up to 4 minutes, with no retained microcatheters during any of the procedures. Pathological sections for resected tumours (meningioma, choroid plexus papilloma, hemangiopericytoma, hemangioendothlioma) showed n-BCA cast in small vessels (20 μm) indicating small vessel penetration. For tumours that underwent resection, no tumour bleeding was encountered during surgical resection. All nine-tumour embolisations for haemorrhage had a 100% response to treatment with no recurrent bleeding; these corresponded squamous cell carcinoma from the nasopharynx extending to the larynx. Patients were followed up to 1–14 months with no repeat episodes of tumour associated bleeding.
Conclusion NBCA/ethiodol augmented with 5% dextrose infusion through the guide catheter provides improved tumour embolisation by deepening vascular penetration. Our preliminary experience has been promising with 19 sessions demonstrating near complete tumour embolisation resulting in minimal tumour related blood loss and complete response to the therapeutic embolisation.
Disclosures A. Alaraj: 2; C; Cordis-Codman. N. Mehta: None. R. Dashti: None. V. Aletich: 2; C; Cordis-Codman.