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Tumor Embolization

Introduction

Tumor embolization is a procedure that can be performed prior to a planned surgical resection. Embolization shuts down the blood supply to a tumor reducing blood loss during surgical resection. A secondary benefit from embolization can be that tumor margins are more easily identified and a tumor can be removed more completely and with less effort. Tumors of the spine, head, and neck that can be embolized have relatively large blood vessels supplying the tumor. Examples of typical tumors with prominent blood supply include: hemangioblastoma, meningioma, juvenile nasal angiofibroma, aneurysmal bone cyst, paraganglioma’s (carotid body, glomus vagale, glomus jugulare), hemangiopericytoma and vascular metastases from renal cell, thyroid, and chorio cancers.

Procedure

Prior to undergoing tumor embolization it is necessary to perform either a cerebral angiogram or a spinal angiogram. A cerebral or spinal angiogram provides a roadmap of the blood vessels of the brain or spine and indicates the blood supply to a tumor. Physicians use this blood vessel roadmap to determine how a particular patient’s brain is supplied with blood and whether a tumor has prominent blood supply that is amenable to embolization treatment.

If a tumor has a prominent blood supply then flow can be shut down to the tumor using 3 types of agents. All agents essentially perform the same task, i.e. reducing blood flow; however, they have slightly different properties and are used for different benefits.

 

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Lateral common carotid angiogram, late arterial phase, showing the tumor vascular blush of a carotid body tumor
Microcatheter injection in the carotid body tumor again showing the tumor
vascular blush
Lateral common carotid angiogram showing no
tumor vascular blush
after embolization

 

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Operating room picture of tumor being removed following an embolization procedure

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