One-stage hybrid operation for hypervascular central nervous system tumors: a single-center experience of 31 cases

Surgical resection for hypervascular central nervous system tumors poses a significant challenge for neurosurgeons. Controversy remains about the effect and safety of the traditional therapeutic mode, which combines preoperative embolization and delayed tumor resection, remain controversial. Whether a one-stage hybrid operation modality offers a novel approach to address treatment challenges in a safer and more effective way remains unknown.

From the neurosurgical operation database, we retrospectively reviewed patients with hypervascular central nervous system tumor patients who underwent one-stage hybrid operation between January 1, 2014, and September 30, 2024. Intraoperative blood loss, the percentage of tumor devascularization, and complications associated with embolization were recorded. Novel embolization strategies used to facilitate the resection of tumors in one-stage hybrid operations were analyzed.

In total, 31 hypervascular central nervous system tumor patients were recruited. The main pathological types included various types of meningiomas (45.2%), hemangioblastomas (16.1%), paragangliomas (9.7%), and solitary fibrous tumors (9.7%). Embolization of tumor-feeding arterial pedicles alone was achieved in 25 patients, and various materials, such as ethylene-vinyl alcohol copolymer, Guglielmi detachable coil, and silk suture segments, were used, in which the tumor blood supply was blocked satisfactorily and the texture became softer postembolization. Intratumoral vascular beds were embolized in six patients. The mean occlusion rate of the target pedicle was 83.3%. Gross-total resection was achieved in 22 patients (71.0%), with a mean blood loss volume of 1127 ± 1114.4 mL (ranging from 150 - 4500 ml). No embolization-related complications occurred. Deterioration of neurological deficits was observed in three patients (9.7%) at discharge.

A one-stage hybrid operation is safe for the treatment of hypervascular central nervous system tumors. A prospective study to evaluating its safety and efficacy compared with separate-stage treatment is needed.