Preoperative Transcatheter Embolization Research Articles

下横隔動脈-肺動脈シャントを有した気管支拡張症に術前動脈塞栓術を施行した 1 切除例

下横隔動脈-肺動脈シャントを有した気管支拡張症に術前動脈塞栓術を施行した 1 切除例

Giant cell reparative granuloma of the pediatric cranium: case report and review of the literature

Giant cell reparative granulomas are rare bone tumors. Although benign, these tumors are locally destructive and can be highly vascular. They seldom occur in the cranial vault. We describe a multidisciplinary approach to a case of giant cell reparative granuloma of the cranium in a 3-year-old patient. A 3-year-old girl female referred to the pediatric neurosurgery department for evaluation of a retro-auricular mass. She had a history of recurrent otitis media with two subsequent courses of antibiotics without resolution. CT imaging revealed an expansive lesion located in the right mastoid region. Open surgical biopsy revealed a hemorrhagic tumor consistent with a giant cell reparative granuloma. Angiography identified a hypervascular tumor blush that was supplied by the occipital artery. Preoperative transcatheter embolization was performed followed by a multidisciplinary surgical resection and reconstruction. Blood loss was minimal, and the patient recovered well after surgery. Preoperative endovascular embolization and a multidisciplinary intraoperative approach with primary resection and cranial vault reconstruction is an effective approach to hypervascular giant cell reparative granulomas.

A Massive Chondroblastoma in the Proximal Humerus Simulating Malignant Bone Tumors

Chondroblastoma is a mostly benign bone neoplasm that typically affects the second decade of life and exhibits a lytic lesion in the epiphysis of long bones. We report an extreme case of massive, destructive chondroblastoma of the proximal humerus in a 9-year-old girl. It was difficult to differentiate using imaging information the lesion from malignant bone tumors such as osteosarcoma. Histopathological examination from biopsy proved chondroblastoma. The tumor was resected after preoperative transcatheter embolization. Reconstructive procedure for the proximal humerus was not performed due to the local destruction. The present case demonstrates clinical and radiological differentiations of the massive chondroblastoma from the other lesions and histopathological understandings for this lesion.

Trans-sacral resection of a solitary fibrous tumor in the pelvis: Report of a case

Solitary fibrous tumors (SFTs) develop most commonly in the pleura, although they have occasionally been reported to arise in the pelvic cavity. We report a case of an SFT presenting as a painless nodule in the pelvis of a 56-year-old woman. Histologically, the tumor was composed of spindle-shaped cells arranged without pattern, with short and narrow fascicles and interspersed bundles of thick collagen, and numerous blood vessels with a focally hemangiopericytoma-like appearance. Immunohistochemically, the tumor cells strongly expressed vimentin, CD34, and bcl-2. The tumor was excised via a trans-sacral approach, without preoperative transcatheter embolization, and the patient remains well more than 2 years after her operation. To our knowledge, this is the first case of an SFT in the pelvis, which was excised completely via a trans-sacral approach.

Preoperative Transcatheter Embolization of Abdominal Pregnancy: Report of Three Cases

Preoperative Transcatheter Embolization of Abdominal Pregnancy: Report of Three Cases

Surgical treatment of carotid paragangliomas presenting unusual technical difficulties: The value of preoperative embolization

Although the application of reconstructive vascular surgical procedures to the treatment of carotid paragangliomas has made their resection the method of choice and has produced excellent cure rates, it has not obviated some of the technical problems presented by excessively vascular, adherent, or bulky lesions. Our experience with preoperative transcatheter embolization for the reduction of the vascularity in six cases of this group of lesions is presented and the conclusion is made that preoperative embolization greatly reduced operative technical difficulties.

Subarachnoid Hemorrhage due to Spinal Tumor

An unusual case involving subarachnoid hemorrhage (SAH) associated with an ependymoma is presented. The patient, a 54-year-old male, was hospitalized because of sudden onset of severe headache and urinary retention. Cerebral angiography revealed no abnormality. An intraspinal lesion was suspected when serial lumbar punctures repeatedly yielded dark, brownish fluid. Further neuroradiological examinations (myelography, spinal computed tomography, and selective spinal arteriography) revealed an intraspinal tumor situated at L1-3. The tumor was totally removed with the aid of preoperative transcatheter embolization. Only 56 cases of SAH due to an intraspinal neoplasm have been reported. Such cases are thought to be uncommon and, in many of those reported, diagnosis was difficult. The possibility of an intraspinal tumor should be considered in SAH patients who present with minimal spinal cord or root signs. In terms of locating and characterizing the hypervascular spinal tumor in the present case, as well as selecting appropriate treatment, selective spinal arteriography was the most contributory procedure.

Embolotherapy in the treatment of congenital arteriovenous malformations of the hand: A case report

This article describes the treatment of a painful ulcerating congenital arteriovenous malformation in the hand of a 39-year-old woman. Preoperative transcatheter embolotherapy was used to diminish vascularity and engorgement. Operative treatment consisted of a resection of angiomatous material and coverage with a pedicle flap. Preoperative transcatheter embolization of small feeder vessels may offer some advantage over the operative approach alone in treating congenital arteriovenous malformations of the hand.

Treatment of Renal Cancer Patients by Transcatheter Embolization and its Effects on Lymphocyte Proliferative Responses

The effects of transcatheter embolization on lymphocyte proliferation in patients with renal cancer were investigated. Prognosis was good in 12 patients who underwent preoperative transcatheter embolization and 2 of 5 patients with distant metastases survived for 2 years or more. The remaining 9 patients underwent transcatheter embolization as a conservative procedure and 4 of 7 with distant metastases survived more than 1 year.Lymphocyte response phytohemagglutinin before treatment in the presence of autologous or homologous serum was significantly lower in all patients than in healthy persons (p less than 0.01 and less than 0.05, respectively). The response after transcatheter embolization decreased slightly only in the presence of autologous serum for a short interval but recovered to the pre-treatment level 1 month after embolization. However, only in the presence of autologous serum was the response significantly higher at 2 months after nephrectomy than before treatment in patients who underwent preoperative transcatheter embolization (p less than 0.05). The serum inhibitory factor levels changed in inverse proportion to the post-treatment lymphocyte response. In patients who underwent preoperative transcatheter embolization the serum inhibitory factors essentially disappeared 2 months after nephrectomy.

Bone metastases from renal carcinoma. The preoperative use of transcatheter arterial occlusion.

Surgical treatment of hypervascular bone lesions can result in excessive operative blood loss. We reviewed the cases of eight patients who were operated on for hypervascular bone metastases from renal carcinoma after preoperative transcatheter embolization. The embolization was successful in six of these patients and their operative blood loss averaged only 550 milliliters (range, 450 to 750 milliliters). The reasons for failure in two patients were failure to recognize and embolize all major vessels supplying the tumor in the first and the presence of too many small vessels arising directly from the superficial femoral artery to embolize safely in the second. When surgical treatment of hypervascular bone metastases is indicated, consideration should be given to preoperative arterial embolization.

Usefulness of preoperative transcatheter embolization in kidney tumors

In recent years preoperative transcatheter embolization has been used widely in the management of kidney tumors. However, the effective clinical usefulness of this method has not yet been proved. Forty cases of kidney tumors treated by preoperative embolization and radical nephrectomy are reviewed and compared with a homogeneous group of patients who did not undergo preoperative embolization. Intraoperative blood loss, postoperative complication, and survival rate were statistically evaluated according to tumor stage. Advantages and disadvantages of preoperative transcatheter embolization of kidney tumors are reviewed.

Embolization of renal carcinoma.

Preoperative transcatheter embolization of a renal neoplasm is helpful to the urologist, especially with large, hypervascular tumors. When combined with nephrectomy and hormonal therapy, it offers promise in the management of patients with renal carcinoma. Delay between embolization and nephrectomy seems to be important, but the optimal time for stimulating a therapeutic response has not been established. Among 49 patients in this series with known metastases, occlusion of the renal artery followed 4 to 7 days later by nephrectomy and hormonal therapy changed the course of the disease, producing a 36% response rate.

Preoperative Embolization of Wilms' Tumors

In two patients with Wilms' tumors, the ipsilateral kidney was nonfunctional. To facilitate initial surgical removal of the tumors, a preoperative transcatheter embolization was performed following diagnostic arteriography. Preoperative embolization of a renal tumor reduces the vascularity of the lesion prior to surgery, and a patient in whom primary surgical removal of the tumor would carry unacceptable risk may be converted into one in whom primary surgical removal is safe.

T and B Lymphocyte Levels in Renal Cancer Patients: Influence of Preoperative Transcatheter Embolization and Radical Nephrectomy

The mean percentage of T and B lymphocytes in peripheral blood was tested in 6 patients with renal cancer before and after preoperative transcatheter embolization and radical nephrectomy. While no significant difference was found in B lymphocyte levels compared to those in healthy control subjects a clear impairment in circulating T lymphocyte levels was observed in renal cancer patients who had not been treated. This reduction in T lymphocyte levels persisted after embolization but there was a significant increase after radical nephrectomy.