Supervisors info:
Καλαματιανός Θεοδόσης, Διδάκτωρ, Ιατρική Σχολή Αθηνών, ΕΚΠΑ
Στράντζαλης Γεώργιος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Πιάγκου Μαρία Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Background: Solitary Fibrous Tumors (SFTs) in the Central Nervous System (CNS) are a rare type of fibroblastic neoplasm that present significant diagnostic and therapeutic challenges. These tumors, accounting for less than 1% of all SFTs, typically arise from the meninges, spinal cord, and cranial nerves. They are highly vascular tumors appearing in diverse and often complex locations within the CNS often making complete surgical excision not feasible. The variable vascularity of SFTs significantly influences complementary possible treatment options, particularly preoperative embolization. This technique, commonly used for hypervascular tumors, serves as an adjunct to surgery. It aims to decrease the tumor's blood supply, thus facilitating safer surgical resections. This can lead to reduced bleeding, shorter surgery time, and lower morbidity and mortality associated with the surgical management of neural tissue and vascular structures.
Methods: We conducted a focused review using PubMed, selecting studies from the last 11 years that discussed preoperative embolization for CNS SFTs. Articles discussing unrelated procedures or other tumor types were excluded. The selected studies were further categorized into three groups based on the CNS regions involved, reflecting their distinct properties and the corresponding embolization techniques used(Intracranial/Spinal/Orbital).
Results: Preoperative embolization, primarily using agents like Onyx, shows potential in reducing perioperative risks by softening tumors and decreasing vascularity. However, effectiveness varies a lot with the tumor's size, location and vascular complexity. Incomplete devascularasation of the tumor, ICA/VB-dominant SFTs and multiple small complex feeders presented to yield only marginal results while also carried an increased risk of complications. Modified Balloon Protection Techniques and intra-operative transcranial or transpedicular embolization respectively in the hybrid operating rooms are able to minimize that risk but studies with bigger samples are needed.
Conclusion: Preoperative embolization shows promising results for improving surgical outcomes in CNS SFTs but demands a customized and tailored approach to address the unique characteristics of each case. Additional research is essential to refine embolization techniques and establish individualized protocols that primarily focus on tumor size and location, integrating a comprehensive angiographic examination of distinct vascular patterns to enhance the long-term success of this treatment strategy.
Keywords:
Preoperative embolization, Solitary fibrous tumors, Hemangiopericytoma, CNS
