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Preoperative Embolization of Hypervascular Tumors

A hypervascular tumor is a tumor characterized by an abnormal increase in blood vessel growth in the area. These vessels feed the tumor cells, and may be characterized by abnormal connections between veins and arteries.

A hypervascular tumor may be

  • Benign (hemangiomas, osteoblastomas, chondromas, etc.)
  • Malignant (chordomas, lymphomas, multiple myelomas, etc.)
  • Metastatic (renal cell carcinomas, thyroid carcinomas, etc.)

They may occur in either the cranium or the spine and they can be difficult to remove surgically due to the risk of bleeding.

Treatment

Whether a hypervascular tumor can be surgically removed or not, blocking or reducing the blood supply to the tumor often is an effective measure. An interventional neuroradiology procedure called endovascular embolization often is used for this.

A clot or other structure that blocks a blood vessel is called an embolus, and the creation of an embolus for therapeutic reasons is called embolization. Like other interventional neuroradiological procedures, embolization involves the insertion of a catheter, or tube, through an artery in the groin. The tube is guided up through the blood vessels to the site of the tumor, where it delivers particles or a liquid embolic agent similar to glue, which clogs up the vessels that feed the tumor.

When deprived of their blood supply through embolization, hypervascular tumors may begin to shrink, a process called tumor necrosis. In patients with tumors that have been deemed inoperable, embolization may be used to reduce the size of the tumor to control symptoms and improve quality of life. In cases in which surgical resection is possible, preoperative embolization is used to make the surgical resection easier. With the blood vessels that feed the tumor blocked off, surgeons can control bleeding more easily. Also, because embolization can make a hypervascular tumor shrink, it can make the resection easier overall. Resection ideally is done 48 to 72 hours after embolization.

Preoperative embolization reduces the risk of complication associated with surgery and can improve the likelihood of a complete resection and positive outcome. Endovascular techniques also may be used to infuse chemotherapeutic agents directly into the blood vessels that feed tumors.

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