Abstract
BackgroundRemoval 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.MethodsWe 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. ResultsIn 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.ConclusionsAlthough further studies are warranted, persistent feeder obliteration of choroidal arteries could be an effective treatment strategy against large hypervascular tumors in the lateral ventricle.
Highlights
Removal of large hypervascular tumors in the lateral ventricle still poses a surgical challenge
Endovascular feeder embolization is preferable due to its minimal invasiveness [7, 8]; a previous case report has shown that microsurgical occlusion of feeders originating from the choroidal arteries in the inferior horn of the lateral ventricle might be an effective method [9]
We aimed to evaluate the clinical efficacy of the strategy of managing large hypervascular tumors in the lateral ventricle surgically, through persistent preoperative obliteration of feeders from the choroidal arteries; we first attempted to obstruct feeders using endovascular treatment; if unavailable, performed initial microsurgical occlusion in the temporal horn for the staged tumor removal
Summary
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. The surgical treatment of large hypervascular tumors in the lateral ventricle, such as meningiomas, remains challenging for neurosurgeons. We aimed to evaluate the clinical efficacy of the strategy of managing large hypervascular tumors in the lateral ventricle surgically, through persistent preoperative obliteration of feeders from the choroidal arteries; we first attempted to obstruct feeders using endovascular treatment; if unavailable, performed initial microsurgical occlusion in the temporal horn for the staged tumor removal
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