Brain Metastases, Brain Neoplasms, Hemangioblastoma, Meningioma
Conditions
Keywords
Preoperative Embolization, Endovascular Embolization, Tumor Devascularization, Digital Subtraction Angiography, Intraoperative Blood Loss, Interventional Neuroradiology, Microsurgical Resection
Brief summary
Highly vascular brain tumors, including meningiomas, hemangioblastomas, and certain metastases, have a rich blood supply that can lead to substantial blood loss and technical difficulties during surgical removal. Preoperative endovascular embolization is an adjunctive, catheter-based procedure used to block the feeding blood vessels of the tumor before surgery, aiming to reduce intraoperative bleeding and facilitate safer tumor resection. The primary purpose of this study is to evaluate the technical feasibility, safety, and effectiveness of preoperative endovascular embolization in patients with highly vascular intracranial tumors. Participants enrolled in this prospective study will undergo: 1. Pre-procedural neurological and diagnostic cross-sectional imaging (contrast-enhanced MRI or CT angiography). 2. Diagnostic digital subtraction angiography (DSA) to map tumor-feeding arteries, followed by super-selective catheterization to deliver embolic materials (polyvinyl alcohol particles, Onyx, or microcoils). 3. Microsurgical tumor resection within 24 to 72 hours following the embolization procedure. Researchers will assess the degree of tumor devascularization achieved, the volume of intraoperative blood loss, blood transfusion requirements, total surgical duration, extent of tumor resection, and the occurrence of any procedure-related complications.
Interventions
PROCEDUREPreoperative Endovascular Embolization
Diagnostic cerebral digital subtraction angiography (DSA) is performed to identify tumor-feeding arteries and exclude dangerous anastomoses. Super-selective microcatheterization is then conducted to deliver embolic materials (polyvinyl alcohol \[PVA\] particles, Onyx, or microcoils) directly into the tumor vasculature. Tumor devascularization is quantified via post-procedural DSA/CT (\<50%, 50-80%, or \>80%). Following endovascular devascularization, patients undergo microsurgical tumor resection within 24 to 72 hours.
Sponsors
Assiut University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Diagnosis of a hypervascular brain tumor (e.g., meningioma, hemangioblastoma, or hypervascular metastasis) confirmed by contrast-enhanced MRI or CT * Scheduled for preoperative endovascular embolization followed by microsurgical resection
Exclusion criteria
* Severe, uncorrected coagulopathy * Severe allergy to iodinated contrast media * Severe renal insufficiency (estimated glomerular filtration rate \[eGFR\] \< 30 mL/min/1.73 m²) * Absence of safe arterial access * Absence of identifiable tumor-feeding vessels suitable for selective microcatheterization
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Achieving Defined Grades of Tumor Devascularization | 24 hours post-embolization | Tumor devascularization is determined by comparing post-embolization digital subtraction angiography (DSA) or CT angiography against baseline diagnostic imaging. Participants are categorized into three predefined grades based on devascularization of tumor vascular blush: poor (\<50%), moderate (50% to 80%), or good/complete (\>80%). |
Outcome results
None listed