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Tumor Embolization (Often Meningiomas):
Some tumors of the brain, head and neck, and spine have a rich blood supply
and studies have shown that embolization (blockage of blood flow) to the
tumor prior to surgical removal result in less operative blood loss, shorter
operative times, and greater chance of complete tumor resection. The most
common tumor we embolize is meningioma. Meningiomas are tumors that grow
from the covering of the brain (meninges). They are usually benign and slow
growing; they usually cause problems when they become large enough to put
pressure on the brain under them. They are more common in women than in men.
Multiple meningiomas can be seen, especially in people with certain
inherited diseases, such as neurofibromatosis.
How are these tumors treated?
These tumors are usually treated surgically. When they are large, or have a
large blood supply (which many meningiomas do), surgical removal is riskier.
In this instance, a catheter can be placed into the blood vessels supplying
the tumor (like an angiogram) and materials (often little particles) can be
injected to block off the blood supply to the tumor (this is called
embolization). This is usually done within a few days of the surgery. The
potential complications and risks of the procedure should be discussed with
your doctor.
What is embolization?
Embolization is an endovascular technique, (performed from within the blood
vessels) to block vessels of the tumor. Embolization is performed using
catheters and angiographic techniques similar to those discussed above. For
the embolization procedure, a very tiny catheter is threaded from the groin
directly into the tumor vessels around the brain, head and neck, or spine.
Under X-ray guidance, material is injected through the catheter to
permanently block and close off the vessels of the tumor. Materials used
might include particles or small platinum coils.
Who performs endovascular embolization procedures?
Endovascular treatment is a relatively new type of treatment requiring
specialized training. Most physicians who perform endovascular embolization
are neuroradiologists or neurosurgeons who have received several years of
additional training in navigating inside the brain blood vessels to treat a
variety of blood vessel disorders.
What do I need to know before having an embolization?
The patient will be told not to eat anything after midnight on the night
before the procedure. This is very important in that any food in the stomach
will make the patient nauseated during the procedure and may cause vomiting
with severe consequences. Patients should take their normal medications the
morning of the procedure with a small amount of water. Embolizations are
performed either under sedation or under general anesthesia. Procedures
frequently take 2 to 3 hours and the time necessary is often not predictable
before the procedure begins.
After the procedure, the patient will need to remain still and avoid bending
the hip where the puncture occurred for at least 6-8 hours. This means lying
flat and is often the portion of the entire experience that is most
uncomfortable. The period of rest is very important since it allows the
small puncture hole in the artery to heal.
Patients usually remain in the hospital for several days following an
embolization procedure, usually until the tumor is surgically removed. The
first night may be spent in the neurological intensive care unit for close
monitoring. If surgery is to follow the embolization procedure, it may be
performed on the day after embolization.
For more information go to: www.asitn.org
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