Preoperative Embolization for Tentorial and Subtentorial Tumors

Area of Science:

• Neurosurgery
• Interventional Radiology
• Vascular Neurology

Background:

• Tentorial and subtentorial tumors pose surgical challenges due to deep location and complex vascularity.
• Preoperative embolization is a potential adjunct to improve surgical outcomes for these tumors.
• Limited data exists on the safety and efficacy of preoperative embolization for tentorial tumors.

Purpose of the Study:

• To review the technical considerations and outcomes of preoperative embolization for tentorial tumors.
• To evaluate the safety and effectiveness of this procedure in a series of patients.
• To detail the embolization techniques and feeder vessel categories.

Main Methods:

• Retrospective review of 29 consecutive preoperative embolization procedures for tentorial tumors.
• Analysis of technical approaches targeting medial (MHT, ILT), lateral (middle meningeal, occipital arteries), and inferior (APA) feeders.
• Assessment of technical success, embolic agents used, and post-embolization complications.

Main Results:

• Technical success rate of 96.6% (28/29 procedures).
• Embolization primarily from MHT/ILT (53.6%) and APA (21.4%); multiple feeders targeted in 46.6%.
• Predominant embolic agents: N-butyl cyanoacrylate (85.7%), coils (39.3%), particles (35.7%).
• Neurological complications in 7.1% (2/29 cases), primarily cranial nerve palsies.
• Tumor necrosis achieved in 60.7%, with complete contrast enhancement disappearance in 10.7%.

Conclusions:

• Preoperative embolization of tentorial tumors is feasible and effective.
• The procedure offers substantial benefits for subsequent surgical resection when performed with expertise.
• Acceptable risks are associated with this technique in complex skull base surgeries.