• Chibawanye I Ene, David Xu, Ryan P Morton, Samuel Emerson, Michael R Levitt, Jason Barber, Robert C Rostomily, Basavaraj V Ghodke, Danial K Hallam, Felipe C Albuquerque, Cameron G McDougall, Laligam N Sekhar, Manuel Ferreira, Louis J Kim, and Steve W Chang.
• ‡Department of Neurological Surgery, University of Washington, Seattle, Washington; §Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; ¶Department of Radiology, University of Washington, Seattle Washington.
• Neurosurgery. 2015 Sep 9.

BackgroundIntracranial hemangioblastomas are highly vascular tumors that account for 1% to 2% of all central nervous system tumors. Preoperative embolization has been proposed to limit the often significant intraoperative blood loss associated with resection and potentially make the tumor more soft/necrotic and thus more amenable to gross total resection. The safety and efficacy of preoperative embolization of intracranial hemangioblastomas, however, are not well characterized.ObjectiveTo evaluate the safety and efficacy of preoperative endovascular embolization of intracranial hemangioblastomas using a variety of embolic agents.MethodsA retrospective review of all surgically resected intracranial hemangioblastomas treated with preoperative embolization between 1999 and 2014 at 2 high-volume centers was performed. Clinical and radiographic criteria, including von Hippel-Lindau status, magnetic resonance imaging tumor characteristics, embolization-related complications, degree of angiographic devascularization, intraoperative blood loss, ability to obtain gross total resection, transfusion requirements, and operative time, were analyzed.ResultsA total of 54 patients underwent surgery, with 24 undergoing preoperative embolization followed by surgical resection, and 30 patients undergoing surgical resection alone. Embolization-related neurological complications were seen in 6 patients (25%), including 3 hemorrhages when polyvinyl alcohol particles (P = .04) were used and 3 infarctions when liquid embolic agents were used (P = .27). Permanent neurological deficits were seen in 15%.ConclusionPreoperative embolization of intracranial hemangioblastomas should be performed with caution, given the potential for neurological morbidity. Further studies are needed to help guide patient and embolic agent selection.Abbreviationsn-BCA, N-butyl cyanoacrylatePVA, polyvinyl alcoholVHL, von Hippel-Lindau.

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