Direct puncture embolization of intracranial solitary fibrous tumor with SQUID.

Solitary fibrous tumors (SFTs) are rare intracranial neoplasms that are highly vascular, making surgical resection challenging due to significant intraoperative blood loss. Preoperative embolization is commonly performed via the transarterial route; however, this approach has limitations, including difficulty in accessing multiple feeders, prolonged procedural time, and the risk of embolic material reflux into the intracranial circulation. Here, we report the case of a 19-year-old male with a large intracranial SFT, initially treated with transarterial embolization using polyvinyl alcohol (PVA) particles, which failed to achieve proper devascularization of the tumor. Consequently, direct puncture embolization using the SQUID 12 agent was performed. Following successful embolization, complete tumor resection was achieved with significantly reduced intraoperative blood loss and no postoperative neurological deficits. This case highlights the effectiveness of direct puncture embolization as a viable alternative to traditional transarterial approaches for managing highly vascular intracranial tumors.