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J Neurol Surg A Cent Eur Neurosurg 2016; 77(04): 361-366
DOI: 10.1055/s-0035-1551823
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Intraoperative Intratumoral Embolization of a Complex Recurrent Hemangiopericytoma: Technical Report and Review of the Literature

Mats Ryttlefors
1   Arkansas Neuroscience Institute, St. Vincent's Infirmary, Little Rock, Arkansas, United States
2   Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
,
Francesco Latini
1   Arkansas Neuroscience Institute, St. Vincent's Infirmary, Little Rock, Arkansas, United States
2   Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
3   Division of Neurosurgery, Department of Neuroscience and Rehabilitation, S. Anna University Hospital, Ferrara, Italy
,
Jaafar Basma
1   Arkansas Neuroscience Institute, St. Vincent's Infirmary, Little Rock, Arkansas, United States
,
Ali F. Krisht
1   Arkansas Neuroscience Institute, St. Vincent's Infirmary, Little Rock, Arkansas, United States
› Author Affiliations
Further Information

Publication History

15 October 2014

10 March 2015

Publication Date:
13 August 2015 (online)

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Abstract

Objective Recurrent brain tumors represent a challenge for neurosurgeons because of the extensive blood loss and the time needed for surgical resection. Only a few hemostatic agents are useful to prevent the bleeding and thus facilitate the surgical resection. Fibrin sealant can be used to achieve sealing, tissue adherence, or hemostasis when other means of hemostasis are inadequate or inappropriate. We report the feasibility and positive effects of direct intratumoral injection of fibrin sealant during resection of a recurrent hemangiopericytoma.

Material and Methods The intraoperative intratumoral injection of fibrin sealant changed the tumor properties of a recurrent hemangiopericytoma of the tentorium with infra- and supratentorial extension. From a loose friable briskly bleeding tumor, this complex lesion became a nonbleeding well-demarcated soft-firm tumor that could easily be dissected off the pial surface and totally resected without extensive bleeding.

Results There are several benefits of intratumoral injection of fibrin sealant in hemangiopericytomas: (1) the extensive bleeding is diminished and blood loss minimized; (2) the restriction of the surgical view by the venous oozing is diminished, making the microsurgical dissection of the tumor capsule off the pial surface easier and safer; (3) the loose consistency of the tumor becomes firmer and facilitates the manipulation of the tumor and leads to a safer resection; and (4) a shorter operating time is needed.

Conclusion The use of intratumoral fibrin glue injection is a safe and useful technique that could be used for hemostasis of highly vascularized tumors to facilitate a safer resection and to reduce blood loss.

Keywords

hemangiopericytoma - fibrin sealant - safety - intraoperative surgical technique - embolization
 

  • References

  • 1 Fredriksson F, Nordborg C, Hallén T, Blomquist E. Haemangiopericytoma presenting with acute intracerebral haemorrhage—a case report and literature review. Acta Oncol 2013; 52 (4) 753-758
    CrossrefPubMedSearch in Google Scholar
  • 2 Rutkowski MJ, Jian BJ, Bloch O , et al. Intracranial hemangiopericytoma: clinical experience and treatment considerations in a modern series of 40 adult patients. Cancer 2012; 118 (6) 1628-1636
    CrossrefPubMedSearch in Google Scholar
  • 3 Louis DN, Ohgaki H, Wiestler OD , et al. WHO Classification of Tumours of the Central Nervous System. 4th ed., Vol 1. Lyon, France: IARC; 2007
    Search in Google Scholar
  • 4 Albala DM, Lawson JH. Recent clinical and investigational applications of fibrin sealant in selected surgical specialties. J Am Coll Surg 2006; 202 (4) 685-697
    CrossrefPubMedSearch in Google Scholar
  • 5 Baxter Healthcare Corporation. Tisseel prescribing information. Available at: http://tisseel.com/us/pdf/2012-0125_PI_TISSEEL_.pdf . Accessed November 19, 2012
    PubMed
  • 6 Cappabianca P, Cavallo LM, Mariniello G, de Divitiis O, Romero AD, de Divitiis E. Easy sellar reconstruction in endoscopic endonasal transsphenoidal surgery with polyester-silicone dural substitute and fibrin glue: technical note. Neurosurgery 2001; 49 (2) 473-475 ; discussion 475–476
    CrossrefPubMedSearch in Google Scholar
  • 7 Kassam A, Horowitz M, Carrau R , et al. Use of Tisseel fibrin sealant in neurosurgical procedures: incidence of cerebrospinal fluid leaks and cost-benefit analysis in a retrospective study. Neurosurgery 2003; 52 (5) 1102-1105 ; discussion 1105
    CrossrefPubMedSearch in Google Scholar
  • 8 Nakajima S, Fukuda T, Hasue M, Sengoku Y, Haraoka J, Uchida T. New technique for application of fibrin sealant: rubbing method devised to prevent cerebrospinal fluid leakage from dura mater sites repaired with expanded polytetrafluoroethylene surgical membranes. Neurosurgery 2001; 49 (1) 117-123
    PubMedSearch in Google Scholar
  • 9 Nakamura H, Matsuyama Y, Yoshihara H , et al. The effect of autologous fibrin tissue adhesive on postoperative cerebrospinal fluid leak in spinal cord surgery: a randomized controlled trial. Spine 2005; 30 (13) E347-E351
    CrossrefPubMedSearch in Google Scholar
  • 10 Kamada M, Fujita Y, Ishii R, Endoh S. Spontaneous intracranial hypotension successfully treated by epidural patching with fibrin glue. Headache 2000; 40 (10) 844-847
    CrossrefPubMedSearch in Google Scholar
  • 11 El-Banhawy OA, Halaka AN, El-Hafiz Shehab El-Dien A, Ayad H. Subcranial transnasal repair of cerebrospinal fluid rhinorrhea with free autologous grafts by the combined overlay and underlay techniques. Minim Invasive Neurosurg 2004; 47 (4) 197-202
    Search in Google Scholar
  • 12 Krayenbühl N, Hafez A, Hernesniemi JA, Krisht AF. Taming the cavernous sinus: technique of hemostasis using fibrin glue. Neurosurgery 2007; 61 (3, Suppl): E52 ; discussion E52
    CrossrefPubMedSearch in Google Scholar
  • 13 Sekhar LN, Natarajan SK, Manning T, Bhagawati D. The use of fibrin glue to stop venous bleeding in the epidural space, vertebral venous plexus, and anterior cavernous sinus: technical note. Neurosurgery 2007; 61 (3, Suppl): E51 ; discussion E51
    CrossrefPubMedSearch in Google Scholar
  • 14 Hernesniemi J, Ishii K, Karatas A , et al. Surgical technique to retract the tentorial edge during subtemporal approach: technical note. Neurosurgery 2005; 57 (4, Suppl): E408 ; discussion E408
    CrossrefPubMedSearch in Google Scholar
  • 15 Boulos PR, Harissi-Dagher M, Kavalec C, Hardy I, Codère F. Intralesional injection of Tisseel fibrin glue for resection of lymphangiomas and other thin-walled orbital cysts. Ophthal Plast Reconstr Surg 2005; 21 (3) 171-176
    CrossrefPubMedSearch in Google Scholar
  • 16 Hönig JF, Merten HA. Surgical removal of intra- and extraoral cavernous lymphangiomas using intraoperative-assisted intralesional fibrin glue injections. J Craniofac Surg 2000; 11 (1) 42-45
    CrossrefPubMedSearch in Google Scholar
  • 17 Lang P, Thrun B, Hofstetter B , et al. Riesenhämangiom des Zungenkörpers Kombinierter Einsatz fremdblutsparender Verfahren zur perioperativen Reduktion von Fremdbluttransfusionen. [Giant hemangioma of the tongue: combined use of perioperative blood conservation procedures]. Anaesthesist 2002; 51 (6) 470-474
    CrossrefPubMedSearch in Google Scholar
  • 18 Kim IM, Yim MB, Lee CY , et al. Merits of intralesional fibrin glue injection in surgery for cavernous sinus cavernous hemangiomas. Technical note. J Neurosurg 2002; 97 (3) 718-721
    CrossrefPubMedSearch in Google Scholar
  • 19 Romani R, Tuominen H, Hernesniemi J. Reducing intraoperative bleeding of juvenile nasopharyngeal angiofibroma. World Neurosurg 2010; 74 (4–5) 497-500
    CrossrefPubMedSearch in Google Scholar
  • 20 Probst EN, Grzyska U, Westphal M, Zeumer H. Preoperative embolization of intracranial meningiomas with a fibrin glue preparation. AJNR Am J Neuroradiol 1999; 20 (9) 1695-1702
    PubMedSearch in Google Scholar
  • 21 Carli DF, Sluzewski M, Beute GN, van Rooij WJ. Complications of particle embolization of meningiomas: frequency, risk factors, and outcome. AJNR Am J Neuroradiol 2010; 31 (1) 152-154
    CrossrefPubMedSearch in Google Scholar
  • 22 Duffis EJ, Gandhi CD, Prestigiacomo CJ , et al; Society for Neurointerventional Surgery. Head, neck, and brain tumor embolization guidelines. J Neurointerv Surg 2012; 4 (4) 251-255
    CrossrefPubMedSearch in Google Scholar
  • 23 Bendszus M, Monoranu CM, Schütz A, Nölte I, Vince GH, Solymosi L. Neurologic complications after particle embolization of intracranial meningiomas. AJNR Am J Neuroradiol 2005; 26 (6) 1413-1419
    PubMedSearch in Google Scholar
  • 24 Rosen CL, Ammerman JM, Sekhar LN, Bank WO. Outcome analysis of preoperative embolization in cranial base surgery. Acta Neurochir (Wien) 2002; 144 (11) 1157-1164
    CrossrefPubMedSearch in Google Scholar
  • 25 Waldron JS, Sughrue ME, Hetts SW , et al. Embolization of skull base meningiomas and feeding vessels arising from the internal carotid circulation. Neurosurgery 2011; 68 (1) 162-169 ; discussion 169
    CrossrefPubMedSearch in Google Scholar
  • 26 Bendszus M, Rao G, Burger R , et al. Is there a benefit of preoperative meningioma embolization?. Neurosurgery 2000; 47 (6) 1306-1311 ; discussion 1311–1312
    CrossrefPubMedSearch in Google Scholar
  • 27 Borghei P, Baradaranfar MH, Borghei SH, Sokhandon F. Transnasal endoscopic resection of juvenile nasopharyngeal angiofibroma without preoperative embolization. Ear Nose Throat J 2006; 85 (11) 740-743 , 746
    Search in Google Scholar
  • 28 Lichtenbaum R, de Souza AA, Jafar JJ. Intratumoral hydrogen peroxide injection during meningioma surgery. Neurosurgery 2006; 59 (4) (Suppl. 02) ONS470-ONS473
    PubMedSearch in Google Scholar
  • 29 Mastronardi L, DeWaele L. Intratumoural hydrogen peroxide injection during resection of metastatic vertebral melanoma. Technical note. Neurosurg Rev 2011; 34 (3) 389-391 ; discussion 391
    CrossrefPubMedSearch in Google Scholar
  • 30 Mut M, Yemisci M, Gursoy-Ozdemir Y, Ture U. Hydrogen peroxide-induced stroke: elucidation of the mechanism in vivo. J Neurosurg 2009; 110 (1) 94-100
    CrossrefPubMedSearch in Google Scholar