Therapeutic Embolization of Cranial Tumors

The aim of embolization is to devascularize the tumor bed by filling intratumoral vascularization as deep as possible into the precapillary level to initiate tumor necrosis, decrease blood loss during surgery and thus make it easier and possibly, more radical, and in tumor of nasal cavity to stop epistaxis (Berenstein, 2004, Valavanis, 2002, Gupta, 2006, Smith, 2006). The procedure is angiographically guided. Embolization of a tumor is performed by either an intraarterial catheterization approach or direct puncture of the tumor artery. Selection of one of these approaches depends of the location, and number of arterial feeders of the tumor. Result of devascularization is verified by contrast enhanced CT or MR imaging. Endovascular therapy is not only limited to devascularization procedures for head and neck tumors. Central nervous system lymphomas can be treated with intraarterial chemotherapy infusions after blood brain barrier disruption (Neuwelt, 1991), and squamous cell carcinomas of the skull base and neck are treated with selective infusions of high dose chemotherapy (Simunek, 1993). In this review, we will discuss the endovascular approach to induce tumor ischemia and necrosis of central nervous system and skull base tumors. In spite of the fact that methods of preoperative devascularization of hypervascularized tumors of the head have been established for many years, the number of patients treated endovascularly using this technique is relatively low. This is mainly due to a small proportion of the head and neck tumors suitable for this therapy and controversies in terms of its risk-benefit ratio (Latchaw, 1993).