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Post-embolization neurological syndrome after embolization for intracranial and skull base tumors: transient exacerbation of neurological symptoms with inflammatory responses

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

Pre-operative embolization is an effective treatment strategy for hypervascular intracranial and skull base tumors. However, neurological complications resulting from tumor swelling, cranial nerve ischemia, or hemorrhage can occur after embolization. The purpose of this study was to examine the relationship between neurological complications following pre-operative embolization and minor adverse events including fever, headache, or increasing inflammation, which are common after embolization for abdominal tumors (i.e., post-embolization syndrome, PES).

Methods

We retrospectively reviewed 39 consecutive patients with pre-operative embolization for intracranial and skull base tumors. Neurological symptoms and minor adverse events were regularly observed after embolization. The degree of devascularization was evaluated using enhanced magnetic resonance imaging. We also evaluated changes in peritumoral edema.

Results

Neurological complications occurred in eight cases, five of whom had exacerbation of existing neurological symptoms, which occurred concurrent with a general inflammatory response. We termed this clinical condition post-embolization neurological syndrome (PENS). The mean time to neurological symptom onset was 37.2 h after embolization. PENS was self-limiting in all cases but one, which required emergency surgery. The remaining three cases were diagnosed with cranial nerve ischemia.

Conclusions

PENS is an important neurological complication after pre-operative embolization, which should be distinguished from ischemic or hemorrhagic complications. PES is a minor complication with favorable prognosis, whereas PENS should be considered as a dangerous clinical sign that may require emergency treatment. Further experiments are needed to elucidate the pathology of PENS.

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References

  1. Raper DMS, Starke RM, Henderson F Jr, Ding D, Simon S, Evans AJ, Jane JA Sr, Liu KC (2014) Preoperative embolization of intracranial meningiomas: efficacy, technical considerations, and complications. AJNR 35:1798–1804

    Article  PubMed  CAS  Google Scholar 

  2. Borg A, Ekanayake J, Mair R, Smedley T, Brew S, Kitchen N, Samandouras G, Robertson F (2013) Preoperative particle and glue embolization of meningiomas: indications, results, and lessons learned from 117 consecutive patients. Neurosurgery 73(2):ons244–252

  3. Ampie L, Choy W, Lamano JB, Kesavabhotla K, Kaur R, Parsa AT, Bloch O (2016) Safety and outcomes of preoperative embolization of intracranial hemangioblastomas: a systematic review. Clin Neurol Neurosurg 150:143–151

    Article  PubMed  Google Scholar 

  4. Mine B, Delpierre I, Hassid S, De Witte O, Lubicz B (2011) The role of interventional neuroradiology in the management of skull base tumours and related surgical complications. B-ENT 7(Suppl 17):61–66

    PubMed  Google Scholar 

  5. Kai Y, Hamada JI, Morioka M, Yano S, Nakamura H, Makino K, Mizuno T, Takeshima H, Kuratsu JI (2006) Clinical evaluation of cellulose porous beads for the therapeutic embolization of meningiomas. AJNR 27:1146–1150

    PubMed  CAS  Google Scholar 

  6. Bendszus M, Monoranu CM, Schütz A, Nölte I, Vince GH, Solymosi L (2005) Neurologic complications after particle embolization of intracranial meningiomas. AJNR 26:1413–1419

    PubMed  Google Scholar 

  7. Wakhloo AK, Juengling FD, Van Velthoven V, Schumacher M, Hennig J, Schwechheimer K (1993) Extended preoperative polyvinyl alcohol microembolization of intracranial meningiomas: assessment of two embolization techniques. AJNR 14:571–582

    PubMed  CAS  Google Scholar 

  8. Singla A, Deshaies EM, Melnyk V, Toshkezi G, Swarnkar A, Choi H, Chin LS (2013) Controversies in the role of preoperative embolization in meningioma management. Neurosurg Focus 35:E17

    Article  PubMed  Google Scholar 

  9. Dhand S, Gupta R (2011) Hepatic transcatheter arterial chemoembolization complicated by postembolization syndrome. Semin Interv Radiol 28:207–211

    Article  Google Scholar 

  10. Grand C, Bank WO, Balériaux D, Matos C, Dewitte O, Brotchi J, Delcour C (1993) Gadolinium-enhanced MR in the evaluation of preoperative meningioma embolization. AJNR 14:563–569

    PubMed  CAS  Google Scholar 

  11. Bendszus M, Warmuth-Metz M, Klein R, Bartsch AJ, Krone A, Tonn JC, Solymosi L (2002) Sequential MRI and MR spectroscopy in embolized meningiomas: correlation with surgical and histopathological findings. Neuroradiology 44:77–82

    Article  PubMed  CAS  Google Scholar 

  12. Bissler JJ, Racadio J, Donnelly LF, Johnson ND (2002) Reduction of postembolization syndrome after ablation of renal angiomyolipoma. AJKD 39:966–971

    Article  PubMed  Google Scholar 

  13. Martin J, Bhanot K, Athreya S (2013) Complications and reinterventions in uterine artery embolization for symptomatic uterine fibroids: a literature review and meta analysis. J Vasc Interv Radiol 36:395–402

    Google Scholar 

  14. Lupattelli T, Basile A, Garaci FG, Simonetti G (2005) Percutaneous uterine artery embolization for the treatment of symptomatic fibroids: current status. Eur J Radiol 54:136–147

    Article  PubMed  Google Scholar 

  15. Hemingway AP, Allison DJ (1988) Complications of embolization: analysis of 410 procedures. Radiology 166:669–672

    Article  PubMed  CAS  Google Scholar 

  16. Lewandowski RJ, Mulcahy MF, Kulik LM, Riaz A, Ryu RK, Baker TB, Ibrahim SM, Abecassis MI, Miller FH, Sato KT, Senthilnathan S, Resnick SA, Wang E, Gupta R, Chen R, Newman SB, Chrisman HB, Nemcek AA Jr, Vogelzang RL, Omary RA, Benson AB 3rd, Salem R (2010) Chemoembolization for hepatocellular carcinoma: comprehensive imaging and survival analysis in a 172-patient cohort. Radiology 255:955–965

    Article  PubMed  PubMed Central  Google Scholar 

  17. Leung DA, Goin JE, Sickles C, Raskay BJ, Soulen MC (2001) Determinants of postembolization syndrome after hepatic chemoembolization. J Vasc Intev Radiol 12:321–326

    Article  CAS  Google Scholar 

  18. Sutton D, Gregson R (1997) Arteriography and interventional angiography. In: Sutton D (ed) A textbook of radiology and imaging. Churchill and Livingstone, Sidcup, pp 694

  19. Scaffaro LA, Kruel CD, Stella SF, Gravina GL, Machado Filho G, Borges de Almeida CP, Pinto LC, Alvares-da-Silva MR, Kruel CR (2015) Transarterial embolization for hepatocellular carcinoma: a comparison between nonspherical PVA and microspheres. Biomed Res Int 2015:435120

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Probst EN, Grzyska U, Westphal M, Zeumer H (1999) Preoperative embolization of intracranial meningiomas with a fibrin glue preparation. AJNR 20:1695–1702

    PubMed  CAS  Google Scholar 

  21. Rosen CL, Ammerman JM, Sekhar LN, Bank WO (2002) Outcome analysis of preoperative embolization in cranial base surgery. Acta Neurochir 144:1157–1164

    Article  PubMed  CAS  Google Scholar 

  22. Richter H-P, Schachenmayr W (1983) Preoperative embolization of intracranial meningioma. Neurosurgery 13:261–268

    Article  PubMed  CAS  Google Scholar 

  23. Gupta AK, Purkayastha S, Bodhey NK, Kapilamoorthy TR, Kesavadas C (2007) Preoperative embolization of hypervascular head and neck tumors. Australas Radiol 51:446–452

    Article  PubMed  CAS  Google Scholar 

  24. Perry A, Chicoine MR, Filiput E, Miller JP, Cross DT (2001) Clinicopathologic assessment and grading of embolized meningiomas: a correlative study of 64 patients. Cancer 92:701–711

    Article  PubMed  CAS  Google Scholar 

  25. Bendszus M, Klein R, Burger R, Warmuth-Metz M, Hofmann E, Solymosi L (2000) Efficacy of trisacryl gelatin microspheres versus polyvinyl alcohol particles in the preoperative embolization of meningiomas. AJNR 21:255–261

    PubMed  CAS  Google Scholar 

  26. Shah AH, Patel N, Raper DM, Bregy A, Ahour R, Elhammady MS, Aziz-Sultan MA, Morcos JJ, Heros RC, Komotar RJ (2013) The role of preoperative embolization for intracranial meningiomas. J Neurosurg 119:364–372

    Article  PubMed  Google Scholar 

  27. Yoon N, Shah A, Couldwell WT, Kalani MY, Park MS (2018) Preoperative embolization of skull base meningiomas: current indications, techniques, and pearls for complication avoidance. Neurosurg Focus 44:E5. 10.3171.2018

  28. Yu SC, Boet R, Wong GK, Lam WW, Poon WS (2004) Postembolization hemorrhage of a large and necrotic meningioma. AJNR 25:506–508

    PubMed  CAS  Google Scholar 

  29. Kallmes DF, Evans AJ, Kaptain GJ, Mathis JM, Jensen ME, Jane JA, Dion JE (1997) Hemorrhagic complications in embolization of a meningioma: case report and review of the literature. Neuroradiology 39:877–880

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We thank the Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan

    Yujiro Tanaka, Takao Hashimoto, Hirofumi Okada, Daichi Kato, Shigeru Aoyagi, Jiro Akimoto & Michihiro Kohno

  2. Department of Neurosurgery, IMS Tokyo Katsushika General Hospital, 4-18-1 Nishi-Shin-Koiwa, Katsushika-ku, Tokyo, 124-0025, Japan

    Daisuke Watanabe

Authors
  1. Yujiro Tanaka
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  2. Takao Hashimoto
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  3. Daisuke Watanabe
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  4. Hirofumi Okada
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  5. Daichi Kato
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  6. Shigeru Aoyagi
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  7. Jiro Akimoto
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  8. Michihiro Kohno
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Corresponding author

Correspondence to Yujiro Tanaka.

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No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Informed consent was obtained from all individual participants included in the study.

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Tanaka, Y., Hashimoto, T., Watanabe, D. et al. Post-embolization neurological syndrome after embolization for intracranial and skull base tumors: transient exacerbation of neurological symptoms with inflammatory responses. Neuroradiology 60, 843–851 (2018). https://doi.org/10.1007/s00234-018-2047-8

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  • DOI: https://doi.org/10.1007/s00234-018-2047-8

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