Embolization Of Feeding Vessels Research Articles

Surgery Combined With Embolization in the Treatment of Plexiform Neurofibroma: A Case Report and Literature Review

Neurofibromatosis type 1 (NF1) is an autosomal dominant multisystem genodermatosis resulting from a mutation on chromosome 17q11.2, characterized by diverse clinical expression with involvement of the skin, nervous system, bones, eyes and other systems. Neurofibromas are tumors located along nerve bundles; when they become large, they are called plexiform neurofibromas. Complications of neurofibromas are rare, but include malignant transformation and potentially life-threatening hemorrhages. A comprehensive perioperative management, including arterial embolization of feeding vessels, is required in order to perform a safe surgical procedure and to reduce potential surgical complications. We report a case of a large plexiform neurofibroma on the right flank, treated in a two-stage approach: first, embolization with polyvinyl alcohol particles of the inferior epigastric, lumbar and superior gluteal arteries on the right and, second, 24 hours after embolization, exeresis of the lesion, which weighed 2.5 kg. Two years after surgery, the patient was asymptomatic, without tumor recurrence and with an important improvement in self-esteem and quality of life

Excisional Curettage of Benign Cystic Lesions.

Treatment of benign cystic lesions of bone with the use of excisional curettage requires careful preoperative planning and patient positioning before the initial incision is made. The initial incision must be carefully planned to expose the entire lesion without violating multiple compartments unnecessarily. A sizeable cortical window must then be made using a high-speed burr followed by evacuation of all cystic contents via curettage. The cavity is copiously irrigated before an adjuvant is used, and the lesion is stabilized, if necessary, before closing. There are many types of alternatives to curettage, such as wide resection, radiation, and embolization of feeding vessels. In orthopaedics, as in all medical specialties, many interventions and techniques have been rendered obsolete and, ultimately, replaced by newer, safer, and more efficient ones. The appeal of curettage has remained because of its procedural simplicity and adaptability in the management of a plethora of diseases such as benign cystic lesions of bone. Additionally, curettage, unlike wide resection, radiation, and embolization of feeding vessels, is minimally invasive and often definitive in nature when used as a treatment modality2. Lastly, curettage grants the performing surgeon the ability to maintain a contained cavity that can be treated with a variety of adjuvant therapies3-17. These reasons listed above make curettage a viable option for the surgical treatment of benign cystic lesions such as giant cell tumors of bone, aneurysmal bone cysts, unicameral bone cysts, chondromyxoid fibromas, and symptomatic nonossifying fibromas.

Transnasal microscopic approach for juvenile nasopharyngeal angiofibroma.

Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign, vascular tumor originating in the nasopharynx. The treatment of choice for JNA is surgical excision. In recent years, surgical management has been greatly influenced by the use of the transnasal endoscopic technique. The aim of the study was to present our experience with the transnasal microscopic removal of JNA. Ten patients with JNA aged 12-17 underwent diagnostics imaging and transnasal microscopic tumor excision. Medical records of patients were retrospectively reviewed. The main outcome measures were complications and recurrences. Preoperative embolization of feeding vessels was performed in 7 patients. According to Andrews' classification, the group included 2 stage I patients, 6 stage II patients and 2 stage IIIA patients with the extensive occupation of the infratemporal fossa. 9 patients had no recurrence in 6-11 years follow up. One stage IIIA patient had a recurrence posteriorly to the pterygopalatine process and it was completely removed. No complications during or after surgery occurred. Transnasal microscopic excision is an effective approach to resect stage I-IIIA JNA.

Transcatheter Arterial Embolization of Pancreatic Arteriovenous Malformation Presenting as Retroperitoneal Bleeding: A Case Report

Pancreatic arteriovenous malformation (AVM) is a rare condition defined as a tumorous formation or vascular anomaly arising from an aberrant bypass anastomosis of the arterial and venous systems in the pancreas (1). Esophageal varix bleeding by portal venous hypertension is the most common complication of pancreatic AVM. Duodenal ulcer bleeding or bleeding from the pancreatic AVM itself are other causes of bleeding associated with this disease entity. Pancreatic AVM presenting as retroperitoneal bleeding is an extremely rare clinical condition and is often misdiagnosed as a pseudoaneurysm. Treatment may include ligation of the afferent artery, embolization of feeding vessels, portacaval shunting, or surgical resection of the affected part or the entire affected organ (2). We report a case of pancreatic AVM presenting as a mesenteric hemorrhage that was successfully treated with transcatheter arterial embolization using n-butyl-2-cyanoacrylate (NBCA). CASE REPORT

Epithelioid hemangioma of the spine: an uncommon cause of spinal cord compression

A 65-year-old female presents to the emergency room with worsening mid-back pain, rapidly progressive numbness starting from below the breasts (T5 sensory level), and bilateral lower extremity weakness. She reported increasing difficulty ambulating and was unsteady on her feet. She had radiating pain into her anterior thighs, occasionally extending into her calves, right greater than left and had new-onset loss of sphincter, bowel and bladder control. Her focused neurologic exam showed quadriceps strength of 4?/5 on the left and 4-/5 on the right. Ankle dorsiflexion was 4-/5 bilaterally. She had a known history of midthoracic back pain for the preceding 4 months. She denied any history of remote or recent spinal trauma. Spinal cord compression was suspected and the initial CT imaging revealed a large lytic lesion at the T7–8 level with involvement of the corresponding ribs. Coronal imaging revealed destruction, expansion and trabeculation of the vertebral bodies of T7–9 and loss of vertebral body height. On axial imaging, there was paravertebral soft tissue extension with central canal narrowing (Figs. 1, 2, 3). An initial differential diagnosis of vascular tumor versus malignancy was considered and a CT-guided biopsy with angiographic embolization of feeding vessels was planned urgently, followed by definitive surgical intervention. She underwent an uneventful biopsy and successful Onyx-18 (eV3, Irvine, California, USA) embolization of feeding vessels (Fig. 3). The post-embolization surgical procedure involved laminectomies from T6 to T9, T7–8 vertebroplasty and partial transpedicular vertebrectomies followed by tumor resection with T4–T11 arthrodesis and posterior spinal fusion (Figs. 4, 5). She regained motor strength within 48 h and near complete resolution of numbness postoperatively. Final pathology was consistent with epithelioid hemangioma (EH).

Giant Arteriovenous Malformation of the Floor of the Mouth Presenting With Dysarthria and Difficulty in Swallowing

Arteriovenous malformation (AVM) is a vascular abnormality resulting in the development of abnormal connection between an artery and vein without capillary connections. An AVM develops mainly intracranially. Extracranial AVMs are rarely seen. Cheek, ear, nose, auricle, and forehead are the more common sites in the extracranial involvement. They cause cosmetic problems when located in the head and neck region. We report a case of a giant AVM in the floor of the mouth, which has not been specified and has not been reported until now. The lesion, in an elderly man, was supplied by multiple vessels and caused difficulty in speaking and swallowing. The lesion was totally excised after embolization of feeding vessels.

Spinal Cord Compression by Thoracic Vertebral Hemangioma—A Case Report

A 68 year old with lower extremity numbness, vibratory sensation loss, coldness and burning of his feet, unsteady gait, frequent falls and a sensory level had an MRI demonstrating aT7 and T8 vertebral body/posterior element lesion with epidural extension, cord compression and foraminal extension (Figures 1-5). Decompressive laminectomy/resection confirmed vertebral hemangioma, a common benign neoplasm that typically remains asymptomatic, found incidentally in 10% of the population. Progressive vertebral body hemangiomas may cause cord or nerve root compression due to epidural tumor extension, expanded bone, hematoma or fracture. Radiographs demonstrate course vertical striations caused by thick trabeculae. CT in indolent lesions demonstrates fat density while compressive lesions demonstrate soft tissue density. Indolent lesions follow fat signal on MRI; symptomatic lesions are T1 isointense/T2 hyperintense. Work-up for aggressive hemangiomas includes angiography to determine vascularity, identify feeding/draining vessels and identify blood supply to the cord. Biopsy helps differentiate hemangioma, lymphoma, myeloma or metastasis. Management of symptomatic hemangiomas includes vertebroplasty for pain, radiation for pain, compression or pre-op and decompressive laminectomy for epidural disease. Embolization of feeding vessels may be performed pre-op or may be curative. Hemangioma causing cord compression and neurologic symptoms by extraosseous extension is much less common than benign hemangioma. Imaging features may suggest potential for progression.

Successful Percutaneous Embolization of Feeding Vessels of a Lung Tumor in a Hydropic Fetus

Fetuses with large lung tumors associated with hydrops have an almost uniformly fatal outcome if left untreated. Indeed, 2 large referral centers in America have reported a perinatal mortality rate approaching 100% in more than 50 hydropic fetuses with lung tumors managed expectantly. 1-3 Fetal intervention, either with open fetal surgery 1-3 or with percutaneous shunting/ablation techniques, 4 can improve the survival rate, but these approaches have only being carried out in few selected cases. We report the successful percutaneous intrauterine embolization of a large echogenic lung mass in a hydropic fetus at 22 weeks' gestation. The prenatal sonographic findings, antenatal course, and perinatal management are presented.

Differentiated Thyroid Carcinoma Presenting With Distant Metastasis at Initial Diagnosis

Distant metastasis (DM) is seldom observed at initial presentation of differentiated thyroid carcinoma (DTC), making it difficult to assess the clinical characteristics and treatment outcomes of DTC patients with DM. We therefore retrospectively assessed these parameters in DTC patients who presented with DM between July 1994 and December 2007. In addition, we compared biologic behaviors and prognostic factors between patients presenting with DM and those developing DM after initial treatment. Among 1560 DTC patients who underwent thyroidectomies during the 13.5-year study period, 91 patients were included in this study; 52 patients (3.4%) displayed DM at initial presentation and 39 (2.5%) developed DM after initial 131 radiacitive iodine (RI) treatment. Metastatic lesions were treated with high dose RI (94.5%), surgical resection (14.3%), external beam radiation therapy (31.9%), embolization of feeding vessels (1.1%), and/or chemotherapy (1.1%). Median duration of follow-up was 75 months (range, 12-158 months). Mean patient age was 57 years (range, 13-80 years), and the female-to-male ratio was 2.03:1. Metastases were detected in the lung only (68.1%), bone only (16.5%), and multiple sites (15.4%). When clinical and tumor characteristics were considered, metastatic lesion iodine avidity was significantly higher in patients presenting with DM. At 5 and 10 years, the overall survival (OS) rates in patients presenting with DM were 83.8% and 72.1%, respectively, and the disease-specific survival (DSS) rates were 68.5% and 26.8%. OS did not differ significantly between patients presenting with DM and those developing DM after initial treatment. However, those with initial DM enjoyed significantly improved DSS compared with patients who developed DM after initial treatment. At last follow-up, 22 patients (24.2%) were alive without disease, 48 (52.7%) were alive with disease, and 21 (23.1%) had died of disease in study patients. Multivariate Cox's regression analyses showed that complete local control was a significant predictor of OS and DSS in all study patients. In patients developing DM after initial treatment, metastatic lesion iodine avidity was also associated with both OS and DSS. In contrast, avidity was associated only with DSS in patients presenting with DM. Our study showed that DTC patients presenting with initial DM appear to have relatively favorable outcomes compared with DTC patients who developed DM after initial treatment. Complete local control may be the most important prognostic indicator in all DM patients. Metastatic lesion iodine avidity had a significant impact on both OS and DSS in patients developing DM after initial treatment, but significantly influenced only DSS in patients presenting with initial DM.

A novel method to control severe upper GI bleeding from metastatic cancer with a hemostatic sealant: The CoStasis surgical hemostat

Control of diffuse bleeding from primary and metastatic cancers in the GI tract is often difficult.1-3 Although surgery is an option, it is infrequently performed in patients with metastatic cancer who are often debilitated and have limited life expectancy. Angiography with embolization of feeding vessels can be used for brisk bleeding, but this may be difficult when multiple lesions are present. Endotherapy by injection, Nd:YAG laser photocoagulation, microwave coagulation, and electrocoagulation have been used with limited efficacy.

Juvenile nasopharyngeal angiofibroma: an update of the UCLA experience, 1960-1985.

The UCLA experience with juvenile angiofibroma (JNA) over a 25-year period is reviewed. There were 83 patients, the majority being adolescent males. Surgery was the primary method of treatment for disease not extending intracranially; 63 of 68 patients (92.5%) became asymptomatic with this modality. In patients treated with a single course of primary radiation, 10 of 14 (78.5%) became asymptomatic. Trends in diagnosis and treatment were evaluated. Contrast computerized tomography reliably assesses tumor extent. Preoperative arteriography is essential for the evaluation and embolization of feeding vessels; this in turn significantly reduces operative blood loss and the need for transfusions. Radiotherapy should be reserved for disease extending intracranially and should be in doses of 3,600 cGy or larger.