STMO-02 Efficacy of preoperative embolization for hemangioblastoma

Introduction: Preoperative transarterial embolization (TAE) for hemangioblastoma carries a risk of cerebral infarction and hemorrhagic complications, and its safety and efficacy are controversial. Method: Twenty-two cases of hemangioblastoma (cerebellar: 18 cases, medulla oblongata: 3 cases, spinal cord: 1 case) treated via direct surgery in our hospital from 2007 to 2020 were enrolled. Results: Preoperative TAE was performed in 6 cases of cerebellar hemangioblastoma (1 bilateral case) and 1 case of spinal hemangioblastoma. The cerebellar hemangioblastoma feeders were only superior cerebellar artery (SCA) in 3 cases, SCA/anterior inferior cerebellar artery (AICA)/posterior inferior cerebellar artery (PICA) in 2 cases, AICA/PICA in 1 case, and single drainer in 5 cases. Tumors were ≥30 mm in all cases (25 mm on 1 side in bilateral cases), and solid or nodular lesions were located on the upper surface of the cerebellum. Cerebellar edema was severe in five cases with hydrocephalus. TAE was performed under local anesthesia in all cases, using a coil alone in two cases and liquid or particle embolization material in five cases. The day before direct surgery, TAE was performed in four cases, one of which underwent emergency decompression due to severe cerebellar edema. Three cases were intentionally embolized on the day of direct surgery. The median blood loss during direct surgery was 100 ml. Although cerebral infarction was observed in all cases, there were no cases of brain stem infarction or hemorrhagic complications. The Modified Rankin Scale at discharge was 0 in 2 cases, 1 in 3 cases, 3 in 1 case, and 4 in 1 case. Discussion/Conclusion: Preoperative TAE for hemangioblastoma reduced the blood loss for direct surgery. Same-day TAE avoided neurological deficit due to cerebral infarction and cerebellar edema. To prevent severe infarction, guiding the microcatheter to the vicinity of the tumor bed is important.