Preoperative partial embolization of thoracic hemangioblastoma
A middle aged woman had paraparesis since many years and had been operated six years back for a thoracic spinal tumor. However, the surgery was an ‘open and close’ one as the surgeon did not take out the tumor.
Post op, the patient rather received radiotherapy, and had been continuing with her paraparesis till one and half years back when her weakness increased and bowel -bladder symptoms appeared.
However she did not undergo any further treatment till now.
At present she had negligible motor power and with significant sensory loss as well in both lower limbs.
A fresh MRI showed the mid dorsal vascular tumor- which later turned out to be hemangioblastoma- with holocord syrinx.
Our neurosurgeon reoperated but could remove only one fourth of the tumor as it bled like hell intra-op.
Two days later I did the angiogram. The tumor was hypervascular and fed by posterior spinal arteries from right 9th and tenth thoracic pedicles.
The segmental arteries as well as the posterior spinals were extremely tortuous and all attempts of superselective microcatheterizations were futile.
RD 9 injection early and late
RD 10 injection early and late
Somehow, the microcatheter could be navigated to the RD9 feeder’s ostium from where PVA particles of size 300-500 microns were injected. This part of the tumor could be completely devascularised.
RD9 embolization early and late
However, the microcatheter could not be navigated even to the ostium of the other feeder.
Then I did the unthinkable. I injected particles right into the main segmental arterial trunk itself.
The capillary blush of the tumor could be decreased significantly and I stopped at this point, leaving the larger arterioles and arteries still patent and well visible.
I was pretty disappointed with the effort and conveyed the results to my surgeon.
However, he went ahead with surgery after two days and to everyone’s surprise almost the entire tumor was significantly devascularised. A small portion inferiorly was still vascular. The entire mass could be removed this time.
The patient has been sent home.
There was no objective neurological improvement till the time of discharge even though the patient said she felt better.
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