Türk Nöroşirürji Dergisi 2022 , Vol 32 , Num 1
Hybrid Tumor Surgery: Clinical Experience and Results
While endovascular techniques were mostly used for aneurysms in the past, hybrid approaches in which endovascular methods are combined with surgical methods have come to the fore in the management of intracranial tumors following technological developments. A vascularizations and vascular neighborhoods of hypervascular, eloquently located or giant complex tumors can be determined by angiography. In addition, with the introduction of embolizing agents, preoperative endovascular embolization can be applied to hypervascular tumors, reducing the vascularity of the tumor or making it completely avascular. Reducing tumor vascularity before surgery simplifies the surgical technique, shortens the operation time, reduces hemorrhagic complications and therefore morbidity and mortality. In this study, we aimed to present the hybrid tumor surgery experience and results. In our clinic, hybrid tumor surgery approach was applied to 5 patients between 2020-2022. While the tumoral lesion of three patients could be embolized almost completely, the major vascularization was reduced by 50% in one patient, but the minor vascularization remained the same due to anastomoses. During the surgery of that four patients, it was observed that the feeding arteries were closed with the embolizing agent, and the surgical technique was simplified perfectly. In the other patient, no catheterizable feeding artery was observed. Addition, in this patient who was scheduled for surgery for a recurrent giant sphenoid wing mass, angiographic revealing of the vascular anatomy and configuration has been a valuable guide for the preservation of nonpathological vascular structures during surgical excision. No complications related to endovascular intervention were encountered. As a result; we believe that hybrid approaches in tumor management facilitate surgical resection and thus reduce morbidity-mortality in selected cases. A hybrid tumor surgery is a current issue and there is not enough data yet. More comprehensive morbidity-mortality studies and cost-effectiveness analyzes to be carried out on this subject are important in terms of revealing more reliable evidences. Anahtar Kelimeler : Brain tumors, Endovascular techniques, Cerebral angiography, Therapeutic embolization