Contrast-Enhanced Ultrasonography and Color Doppler: Guided Intraoperative Embolization of Intracranial Highly Vascularized Tumors.
Brain Neoplasms
/ diagnostic imaging
Contrast Media
Cranial Fossa, Posterior
Embolization, Therapeutic
/ methods
Female
Hemangioblastoma
/ diagnostic imaging
Humans
Intraoperative Care
/ methods
Middle Aged
Neurosurgical Procedures
/ methods
Surgery, Computer-Assisted
Ultrasonography
/ methods
Ultrasonography, Doppler, Color
/ methods
Brain tumor
Color Doppler
Contrast-enhanced ultrasonography
Hemangioblastoma
Intraoperative embolization
Ultrasonography
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
received:
19
03
2019
revised:
15
05
2019
accepted:
16
05
2019
pubmed:
28
5
2019
medline:
21
1
2020
entrez:
28
5
2019
Statut:
ppublish
Résumé
Preoperative embolization is often considered mandatory in highly vascularized brain tumors to contain blood loss. However, not all lesions are amenable to endovascular preoperative embolization. In the literature, cases of preoperative and intraoperative embolization are described only by arterial catheterization, whereas experiences of tumor embolization through direct puncture of the lesion are anecdotal; furthermore these cases lack an intraoperative control method to assess the effects of the embolizing procedure itself. We describe the association of contrast enhanced ultrasonography (CEUS) and color Doppler ultrasonography (CDUS) to perform intraoperative embolization in an illustrative case of a posterior cranial fossa hemangioblastoma not amenable to a preoperative endovascular procedure. The combination of CEUS and CDUS was tested as an option for the intraoperative devascularization of tumors in which preoperative embolization is considered risky or not possible. The association of CEUS and CDUS provided real-time intraoperative data that directly guided the intraoperative embolization and provided reliable data about the hemodynamic effects produced after the direct injection of an embolizing agent. The technique offered a true real-time definition of the anatomic characteristics of the lesion and its relationships with the adjacent structures while distinguishing feeding from draining vessels. This technique has been proved to be a valuable tool in the surgical resection of highly vascularized tumors and in the treatment of intracranial and spinal vascular lesions and can be considered an option in those cases in which preoperative embolization is not possible. It is a feasible, modern, and cost-effective intraoperative imaging technique that allows identification of unexposed anatomic structures, hence minimizing surgical exposition and surgical manipulation.
Sections du résumé
BACKGROUND
BACKGROUND
Preoperative embolization is often considered mandatory in highly vascularized brain tumors to contain blood loss. However, not all lesions are amenable to endovascular preoperative embolization. In the literature, cases of preoperative and intraoperative embolization are described only by arterial catheterization, whereas experiences of tumor embolization through direct puncture of the lesion are anecdotal; furthermore these cases lack an intraoperative control method to assess the effects of the embolizing procedure itself.
METHODS
METHODS
We describe the association of contrast enhanced ultrasonography (CEUS) and color Doppler ultrasonography (CDUS) to perform intraoperative embolization in an illustrative case of a posterior cranial fossa hemangioblastoma not amenable to a preoperative endovascular procedure. The combination of CEUS and CDUS was tested as an option for the intraoperative devascularization of tumors in which preoperative embolization is considered risky or not possible.
RESULTS
RESULTS
The association of CEUS and CDUS provided real-time intraoperative data that directly guided the intraoperative embolization and provided reliable data about the hemodynamic effects produced after the direct injection of an embolizing agent. The technique offered a true real-time definition of the anatomic characteristics of the lesion and its relationships with the adjacent structures while distinguishing feeding from draining vessels.
CONCLUSIONS
CONCLUSIONS
This technique has been proved to be a valuable tool in the surgical resection of highly vascularized tumors and in the treatment of intracranial and spinal vascular lesions and can be considered an option in those cases in which preoperative embolization is not possible. It is a feasible, modern, and cost-effective intraoperative imaging technique that allows identification of unexposed anatomic structures, hence minimizing surgical exposition and surgical manipulation.
Identifiants
pubmed: 31132498
pii: S1878-8750(19)31419-6
doi: 10.1016/j.wneu.2019.05.142
pii:
doi:
Substances chimiques
Contrast Media
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
547-555Commentaires et corrections
Type : ErratumIn
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.