Yukihiro Yamao1, Kazumichi Yoshida2, Akira Ishii2, Masahiro Tanji2, Masakazu Okawa2, Yohei Mineharu2, Takayuki Kikuchi2, Yoshiki Arakawa2, Hiroharu Kataoka2,3, Yasushi Takagi4, Susumu Miyamoto2. 1. Department of Neurosurgery, Kyoto University Graduate School of Medicine, ShogoinKawahara-cho, Sakyo-ku, 606-8507, Kyoto, Japan. yyamao@kuhp.kyoto-u.ac.jp. 2. Department of Neurosurgery, Kyoto University Graduate School of Medicine, ShogoinKawahara-cho, Sakyo-ku, 606-8507, Kyoto, Japan. 3. Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan. 4. Department of Neurosurgery, Tokushima University, Tokushima, Japan.
Abstract
BACKGROUND: Removal of large hypervascular tumors in the lateral ventricle still poses a surgical challenge. These tumors are usually fed from choroidal arteries, and vascular control is typically performed late during the removal. We aimed to evaluate the clinical efficacy of our strategy for persistent preoperative obliteration of feeders from the choroidal arteries to manage large hypervascular tumors in the lateral ventricle. METHODS: We retrospectively analyzed six patients with hypervascular tumors in the lateral ventricle. We first attempted to obstruct feeders using endovascular treatment, and, if unavailable, performed initial microsurgical occlusion through the temporal horn for the staged tumor removal. RESULTS: In all patients, feeder obliteration was successfully performed; the anterior choroidal arteries were occluded by the endovascular treatment and microsurgical occlusion in one and five patients, respectively, while the lateral posterior choroidal arteries were occluded via endovascular treatment in four patients. No patients had permanent symptoms due to feeder obliteration, and tumor devascularization was achieved at the mean rate of 69.9%. During the tumor removal, the mean blood loss volume was 253 ml. No postoperative hemorrhage had occurred, and all patients scored ≤ 2 on the modified Rankin Scale at six months post-removal. CONCLUSIONS: Although further studies are warranted, persistent feeder obliteration of choroidal arteries could be an effective treatment strategy against large hypervascular tumors in the lateral ventricle.
BACKGROUND: Removal of large hypervascular tumors in the lateral ventricle still poses a surgical challenge. These tumors are usually fed from choroidal arteries, and vascular control is typically performed late during the removal. We aimed to evaluate the clinical efficacy of our strategy for persistent preoperative obliteration of feeders from the choroidal arteries to manage large hypervascular tumors in the lateral ventricle. METHODS: We retrospectively analyzed six patients with hypervascular tumors in the lateral ventricle. We first attempted to obstruct feeders using endovascular treatment, and, if unavailable, performed initial microsurgical occlusion through the temporal horn for the staged tumor removal. RESULTS: In all patients, feeder obliteration was successfully performed; the anterior choroidal arteries were occluded by the endovascular treatment and microsurgical occlusion in one and five patients, respectively, while the lateral posterior choroidal arteries were occluded via endovascular treatment in four patients. No patients had permanent symptoms due to feeder obliteration, and tumor devascularization was achieved at the mean rate of 69.9%. During the tumor removal, the mean blood loss volume was 253 ml. No postoperative hemorrhage had occurred, and all patients scored ≤ 2 on the modified Rankin Scale at six months post-removal. CONCLUSIONS: Although further studies are warranted, persistent feeder obliteration of choroidal arteries could be an effective treatment strategy against large hypervascular tumors in the lateral ventricle.
Authors: Alexander Bertalanffy; Karl Roessler; Oskar Koperek; Ellen Gelpi; Daniela Prayer; Markus Neuner; Engelbert Knosp Journal: Neurosurg Rev Date: 2005-09-24 Impact factor: 3.042
Authors: Jason A Ellis; Randy D'Amico; Michael B Sisti; Jeffrey N Bruce; Guy M McKhann; Sean D Lavine; Philip M Meyers; Dorothea Strozyk Journal: Expert Rev Neurother Date: 2011-04 Impact factor: 4.618