Ding Dale, Kreitel Derek, Liu Kenneth C
Department of Neurosurgery; University of Virginia; Charlottesville, VA, United States -
Interv Neuroradiol. 2013 Dec;19(4):466-70. doi: 10.1177/159101991301900410. Epub 2013 Dec 18.
Intracranial hemangiopericytomas are uncommon but highly vascular dural-based tumors which commonly derive arterial blood supply from both intracranial and extracranial circulations. Microsurgical resection of these lesions may result in excessive blood loss without the aid of pre-operative embolization. We describe a case of a large tentorial hemangiopericytoma for which initial resection was aborted due to excessive blood loss. After failed endovascular access, we performed a direct transcranial puncture of the hemangiopericytoma through the craniotomy defect and successfully embolized the tumor with Onyx. Post-embolization gross total resection was achieved with a limited amount of operative blood loss. Direct puncture embolization provides several advantages over traditional endovascular embolization including decreased procedural duration, circumventing challenging arterial anatomy, and a lower risk of stroke in the presence of extracranial-to-intracranial anastamoses. While direct puncture embolization has been described for tumors of the neck and skull base, this is the first reported case of an intracranial hemangiopericytoma successfully devascularized by direct transcranial puncture Onyx embolization.
颅内血管外皮细胞瘤并不常见，但却是基于硬脑膜的高血管性肿瘤，通常从颅内和颅外循环获取动脉血供。在没有术前栓塞辅助的情况下，对这些病变进行显微手术切除可能会导致大量失血。我们描述了一例大型小脑幕血管外皮细胞瘤病例，该病例因失血过多，首次切除手术被迫中止。在血管内介入失败后，我们通过开颅缺损处对血管外皮细胞瘤进行了直接经颅穿刺，并成功使用Onyx栓塞了肿瘤。栓塞后实现了肿瘤全切除，术中失血量有限。与传统血管内栓塞相比，直接穿刺栓塞具有几个优点，包括缩短手术时间、避开复杂的动脉解剖结构以及在存在颅外至颅内吻合的情况下降低中风风险。虽然已经有针对颈部和颅底肿瘤的直接穿刺栓塞的报道，但这是首例通过直接经颅穿刺Onyx栓塞成功使颅内血管外皮细胞瘤去血管化的病例报告。
