Preoperative Embolization as a Strategy to Mitigate Hemorrhage Risk in Surgical Resection of Spinal Hemangioblastomas

Abstract

Objectives: This study aims to explore the interest and indications of preoperative embolization as an adjunctive technique to mitigate hemorrhage risk during surgical resection of spinal hemangioblastomas.

Background: Spinal hemangioblastomas are benign vascular tumors that pose a surgical challenge due to the risk of intraoperative hemorrhage. The standard treatment for these tumors is surgical resection, but the potential for significant bleeding necessitates additional strategies to enhance safety.

Methods: A comprehensive literature review was conducted using reputable databases, including PubMed and Medline in May 2023. Studies focusing on the surgical management of spinal hemangioblastomas and the use of preoperative embolization were reviewed. The emphasis was placed on evaluating the benefits and indications of preoperative embolization in reducing hemorrhage risk during surgical resection. The search terms used were “Hemangioblastoma,” “haemangioblastoma ,” “spinal cord,” and “embolization”.

Results: In our review, a total of 17 studies met our criteria, encompassing 69 patients. The age range varied from 16 to 71 years. Common symptoms at the time of diagnosis included progressive back pain with radiculalgia, motor deficits, urinary disturbances, and hyperreflexia. The cervical region was the most frequent site of involvement (66.7%), followed by the thoracic region (15.9%). The majority of cases had tumors larger than 3 centimeters. The time interval between embolization and surgery ranged up to four months. Total tumor resection was achieved in most patients, except for one case. Among the 69 patients, 61 patients (88.4%) experienced less bleeding than expected.

Conclusion: Preoperative embolization of hemangioblastomas is a useful technique that can make surgical resection safer and more effective. We recommend considering it after multidisciplinary consultation involving neurosurgeons and interventional neuroradiologists.