Preoperative Embolization for Highly Vascular Brain Tumors

N/ANot Yet RecruitingNCT07823985

Assiut University55 enrolled

Overview

Highly vascular brain tumors, including meningiomas, hemangioblastomas, and certain metastases, have a rich blood supply that can lead to substantial blood loss and technical difficulties during surgical removal. Preoperative endovascular embolization is an adjunctive, catheter-based procedure used to block the feeding blood vessels of the tumor before surgery, aiming to reduce intraoperative bleeding and facilitate safer tumor resection. The primary purpose of this study is to evaluate the technical feasibility, safety, and effectiveness of preoperative endovascular embolization in patients with highly vascular intracranial tumors. Participants enrolled in this prospective study will undergo: 1. Pre-procedural neurological and diagnostic cross-sectional imaging (contrast-enhanced MRI or CT angiography). 2. Diagnostic digital subtraction angiography (DSA) to map tumor-feeding arteries, followed by super-selective catheterization to deliver embolic materials (polyvinyl alcohol particles, Onyx, or microcoils). 3. Microsurgical tumor resection within 24 to 72 hours following the embolization procedure. Researchers will assess the degree of tumor devascularization achieved, the volume of intraoperative blood loss, blood transfusion requirements, total surgical duration, extent of tumor resection, and the occurrence of any procedure-related complications.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Brain Neoplasms

Interventions

Preoperative Endovascular EmbolizationPROCEDURE

Diagnostic cerebral digital subtraction angiography (DSA) is performed to identify tumor-feeding arteries and exclude dangerous anastomoses. Super-selective microcatheterization is then conducted to deliver embolic materials (polyvinyl alcohol \[PVA\] particles, Onyx, or microcoils) directly into the tumor vasculature. Tumor devascularization is quantified via post-procedural DSA/CT (\<50%, 50-80%, or \>80%). Following endovascular devascularization, patients undergo microsurgical tumor resection within 24 to 72 hours.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Diagnosis of a hypervascular brain tumor (e.g., meningioma, hemangioblastoma, or hypervascular metastasis) confirmed by contrast-enhanced MRI or CT * Scheduled for preoperative endovascular embolization followed by microsurgical resection Exclusion Criteria: * Severe, uncorrected coagulopathy * Severe allergy to iodinated contrast media * Severe renal insufficiency (estimated glomerular filtration rate \[eGFR\] \< 30 mL/min/1.73 m²) * Absence of safe arterial access * Absence of identifiable tumor-feeding vessels suitable for selective microcatheterization

Outcomes

Primary Outcomes

Number of Participants Achieving Defined Grades of Tumor Devascularization

Tumor devascularization is determined by comparing post-embolization digital subtraction angiography (DSA) or CT angiography against baseline diagnostic imaging. Participants are categorized into three predefined grades based on devascularization of tumor vascular blush: poor (\<50%), moderate (50% to 80%), or good/complete (\>80%).

Time frame: 24 hours post-embolization