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Case series
3D-guided direct puncture therapeutic embolization of intracranial tumors
  1. Jildaz Caroff1,
  2. Nidhal Benachour1,
  3. Léon Ikka1,
  4. Jérôme Nevoux2,
  5. Fabrice Parker3,
  6. Valerio Da Ros1,4,
  7. Cristian Mihalea1,5,
  8. Marta Iacobucci1,6,
  9. Jacques Moret1,7,
  10. Laurent Spelle1,7
  1. 1Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France
  2. 2Department of Otorhinolaryngology, Le Kremlin-Bicêtre, France
  3. 3Department of Neurosurgery, Bicêtre Hospital, Le Kremlin-Bicêtre, France
  4. 4Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata, Rome, Italy
  5. 5Department of Neurosurgery, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
  6. 6Department of Bioimaging and Radiological Sciences, Policlinico “A. Gemelli”. Rome, Italy
  7. 7Faculté de Médecine, Université Paris Sud, Le Kremlin-Bicêtre, France
  1. Correspondence to Dr Jildaz Caroff, Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, 78 Rue du General Leclerc, Le Kremlin-Bicêtre 94270, France; Jildaz.caroff{at}


Background Direct punctures of intracranial tumors have rarely been described in the literature.

Objective To assess the feasibility, safety, efficacy, and advantages of using 3D DSA-guided direct puncture rather than the traditional transarterial route to preoperatively devascularize intracranial lesions in particular clinical situations, paying special attention to any correlation with surgical observations; we present the largest series to date.

Methods Between July 2015 and July 2016, data from all presurgical embolizations performed in our institution were prospectively collected. Information on tumor type, location, size, eventual bone erosion, complications, devascularization percentage, and estimated blood loss was analyzed.

Results Tumors of four patients (two meningioma, two endolymphatic sac tumor) were embolized using direct puncture. 3D XperGuide planning software was used in all procedures. Embolization was feasible in all cases. In one case, a small craniotomy was specifically performed to allow needle positioning. In all cases n-butyl cyanoacrylate was used. No ischemic or hemorrhagic complications related to embolization occurred. Complete or near complete devascularization was obtained in all cases. In one case, surgery was not performed and the patient was monitored. Resection was complete without significant blood loss in two cases, and resection was incomplete but satisfactory in one case.

Conclusions In selected cases, 3D-guided direct puncture of intracranial tumors appears safe, feasible, and efficient for preoperative embolization.

  • Embolic
  • Intervention
  • Liquid Embolic Material
  • Malignant
  • Tumor

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  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Assistance Publique - Hôpitaux de Paris.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors are willing to share spreadsheets from their data extraction on request.