Neurointervention.  2017 Sep;12(2):116-121. 10.5469/neuroint.2017.12.2.116.

Improving Forward Infusion Pressure during Brain Tumor Embolization with the Double Catheter and Coil Technique

• Dayawansa
• Konda S
• Lesley WS
• Noonan PT
• Huang JH

• KMID: 2389504
• DOI: http://doi.org/10.5469/neuroint.2017.12.2.116

Abstract

Endovascular embolization or embosurgery of brain tumors can be used to reduce neoplasm vascularity prior to surgical resection. Two challenges with embosurgery relate to insufficient perfusion pressure into the tumor and inadvertent escape of infused agents into parenchymal branches of the adjacent brain. This report describes a multi-catheter and coil technique to improve tumor perfusion and prevent reflux into normal branches.

Keyword

Transarterial embolization; Preoperative embolization; Brain tumor

MeSH Terms

Brain Neoplasms*
Brain*
Catheters*
Perfusion
United Nations

Figure

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  Fig. 1 Baseline axial (A) and sagittal (B), and post-resection axial (C) and sagittal (D) T1 enhanced MR images of the foramen magnum meningioma.

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  Fig. 2 Native (A) and subtracted (B) angiograms of the right vertebral C2 (black arrow) and the C3 branch tumoral pedicles (white arrows). Both pedicles supplied the enhancing mass, and both demonstrated retrograde reflux into the vertebral artery when either adjacent branch was injected.

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  Fig. 3 Subtracted angiograms via microcatheters in the right vertebral C2 (A) and C3 (B) branch tumoral pedicles. Reflux (white arrows) along the C2 microcatheter back into the vertebral artery occurs during injection of either the C2 (A, black arrow) or C3 (B, black arrow) microcatheters. The non-injection C3 microcatheter (A) and the C2 microcatheter (B) are not well visualized due to subtraction.

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  Fig. 4 With a catheter in the C3 branch (A, B, white arrow), PVA embolization was safely performed because of the coil protection provided by the double catheter technique in the adjacent C2 branch (A, B, black arrow).

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