Application of neurointerventional technique in treatment of rich-vascularized tumor: A report of 234 cases

Objective To investigate the role of neurointerventional technique in the diagnosis and treatment of cranial and spinal rich-vascularized tumor (RVT). Methods A retrospective analysis was conducted on the clinical data of 234 cases of RVT admitted to Department of Neurosurgery, Shanghai Putuo District People′s Hospital from January 2008 to December 2017. All patients underwent head CT, MRI, CT angiography (CTA) or magnetic resonance angiography (MRA) before surgery, and were initially judged as suspected RVT. Afterwards, digital subtraction angiography (DSA) was performed to evaluate the blood flow, arteriovenous distribution and involvement of the tumor, and further neurological intervention was performed for patients who met the embolization indication. Postoperative DSA was used to evaluate the embolization effect, which was divided into 4 grades (excellent, good, fair, poor). Tumor resection was performed 1 day or 6 to 9 days after embolization. According to whether the patient was treated with interventional therapy, he/she was divided into interventional treatment group and non-intervention treatment group. The intraoperative blood loss, postoperative complication rate and complete tumor resection rate were compared between the two groups. Results Of the 234 patients, 56 (23.9%) did not need embolization, and 178 (76.1%) required embolization, of which 127 (71.3%) had vessels suitable for embolization, and 51 (28.7%) had no suitable vessels. The embolization results of 127 patients were excellent in 34 cases (26.7%), 62 cases (48.8%) were good, 26 cases (20.5%) were fair, and 5 cases (4.0%) were poor. The overall embolization rate was 96.1% (122/127). Complications occurred in 3 patients after operation, 2 of which were transient neurological damage and 1 was stroke. Of the 234 patients, 127 were in the interventional group and 107 were in the non-intervention group. There were no significant differences in gender, age, surgical approach or pathological type between the two groups (all P>0.05). Compared with patients without interventional therapy, the intraoperative blood loss was lower in the intervention group (571.3±100.3 ml vs. 1 020.4±267.9 ml, P<0.001), and the postoperative complication rate was lower [4.7%(6/127) vs. 12.1%(13/107), P=0.038] and the tumor resection rate was higher [91.3%(116/127) vs. 80.4%(86/107), P=0.015]. Conclusions The neurointerventional technique seems safe and effective in the evaluation and treatment of RVT, which could decrease intraoperative blood loss, improve the rate of total resection and reduce related postoperative complications. Key words: Brain; Spine; Embolization, therapeutre; Rich-vascularized tumor