Pre-operative embolization is a minimally invasive procedure designed to reduce blood flow to tumors in areas like the head, neck, spine, and organs such as the kidneys and liver. Tumors like meningiomas, paragangliomas, and certain cancers have a complex blood supply that supports their growth. By targeting these blood vessels, embolization limits the tumor’s oxygen and nutrient intake, making subsequent surgical removal safer and more effective. The procedure involves an interventional radiologist who uses imaging guidance to insert a catheter into an artery leading to the tumor. Embolic agents, such as microspheres or metal coils, block the tumor’s blood supply, effectively “starving” it. This method reduces intraoperative bleeding, shortens surgery time, and improves tumor visibility, enabling precise removal. Pre-operative embolization is beneficial for patients undergoing complex tumor surgeries, as it increases safety and reduces recovery time. However, risks like post-embolization syndrome and rare cases of non-target embolization exist but are minimized with proper imaging and expert care. This technique has become a valuable tool in pre-surgical planning, enhancing outcomes for high-risk surgeries while minimizing complications.
Tumours that form and grow in the head, neck and spine have a distinct and elaborate blood supply network. This dedicated blood supply network supplies the tumour with the nutrients and oxygen it needs to grow alarmingly. This includes various types of tumours such as meningioma (tumours on the brain and spinal membranes), paraganglioma (tumours on the head and neck nerves), head and neck cancer, and tumours on the vertebrae (bones of the spinal cord). Pre-operative embolization of tumours is an advanced, minimally invasive procedure to reduce blood flow to the tumour. This procedure is performed before surgical removal of the tumour, to make it safer and more effective. By decreasing the blood supply to the tumour before surgery, pre-embolisation helps shrink the size of the tumour and reduce blood loss. This also improves the visibility of the tumour during the surgery, ensuring the surgeon can easily remove the entire tumour. In this article, let’s look at the different types of tumours commonly treated with embolisation, methods of the procedure, benefits and associated risks.
Pre-operative embolisation is performed before a surgical removal of the tumour. This procedure is commonly used to treat brain tumours, especially meningiomas. Meningiomas are highly vascular tumours, and embolizing them before surgery reduces blood loss significantly. This is particularly useful when the brain tumours are close to critical brain structures. Surgeons can work more precisely, with better visualization and lower risk of brain bleeds when the tumour is embolisation. Renal cell carcinoma and other kidney tumours due for a partial nephrectomy also benefit from pre-operative embolisation. The embolisation of the tumour simplifies removal and preserves kidney function when resection is not feasible. Liver tumours also benefit from pre-operative embolisation. Although liver tumours can be treated with trans arterial chemoembolization (TACE) or transarterial radioembolization (TARE), when surgical resection of the liver tumour is planned, cutting off its blood supply and choking the tumour before removal greatly improves the success rate of the surgery.
Before a tumour can be treated with pre-operative embolisation, we need detailed images of the tumour and its blood supply network. The patient will undergo a CT scan, MRI scan, Cerebral angiogram or spinal angiogram. These tests provide the doctor with a detailed roadmap of the vessels supplying blood to the tumour. With these details, they can plan how to cordon off the tumour’s blood supply, without damaging healthy tissue.
The pre-operative embolisation is a minimally invasive procedure and is performed under local anaesthesia and sedation to keep the patient calm. The procedure is performed by an interventional radiologist, using real-time fluoroscopy visualization to guide their surgical tools and equipment. Depending on the location of the tumour, the surgeon will choose and incision site. A small incision is made in the skin, and a thin catheter is inserted into an artery, usually the femoral artery in the groin or the jugular artery in the neck. From the incision site, the catheter is threaded through the vascular network to the location of the tumour. The catheter is guided to the arteries feeding the tumour. Once in place, an embolic agent is released. The embolic agent sets in the artery, blocking off oxygen and nutrients to the tumour. The tumour is systematically starved this way, reducing its ability to grow.
The embolic agent used in the procedure is dependent on the characteristics of the tumour. The radiologist may use microspheres to obstruct smaller blood vessels that branch off within the tumour. Metal coils made of platinum or platinum alloys are used block off larger blood vessels. The coil is deployed from the end of the catheter and forms a mesh within the vessel being treated. More coils are then deployed into this mesh to reinforce it. Liquid embolic agents like n-butyl cyanoacrylate (NBCA) can also be used. Liquid embolic agents work in a similar way to super glue – They dry rapidly after permeating the blood vessel, effectively blocking it. Gelatin sponges are commonly used as short-term embolizing agents.
Hospitals are increasingly using pre-operative embolisation as a strategy to increase success rates in tumour removal surgeries. Let’s take a look at some of the benefits of pre-operative embolisation:
Reduces Blood Loss – Cutting off the tumour’s blood supply before the open surgical resection has proven to greatly reduce intraoperative bleeding. This has also minimized the need for blood transfusions during surgery. Patients have lower chances of bleeding out during surgery as a direct consequence of the embolisation. In addition to improved safety, pre-operative embolisation also improves visibility of the tumour during surgery. There is less bleeding into the surgical cavity, allowing the surgeon to dissect the tumour with more precision.
Shorter Surgical Time – Pre-operative embolisation helps minimize bleeding during surgery. The surgeon can work more quickly and with greater precision when pre-operative embolisation is done. The patient is under anaesthesia for a shorter duration of time, improving safety and patient outcomes. Studies also show that pre-operative embolisation before a tumour removal surgery results in quicker patient recovery and lower rates of post-operative complications.
Better Surgical Outcomes – The surgeon has better control over tumour delineation, especially in challenging parts of the body like the brain, neck and liver, when pre-operative embolisation has been done. Minimal bleeding during surgery has a direct correlation with more successful resections and lower chances of recurrence of the tumour. Long-term outcomes for patients are much better when preoperative embolisation is performed.
Minimally invasive Procedure – Embolization is a minimally invasive procedure. It is relatively risk-free and doesn’t take a toll on the patient’s fragile health. There is no anaesthesia involved. It provides an advantage in terms of risk management, as the tumour is pre-treated before surgical removal. It also provides options for patients who are not strong enough for surgery yet, keeping the tumour small enough to operate on once the patient is stronger.
Pre-operative embolisation is generally safe. However, even safe procedures carry certain risks, depending on the tumour’s location and the patient’s age and general health. Potential complications of this procedure include:
Post-embolization Syndrome – Some patients experience a flu-like illness after the embolisation procedure. They may experience symptoms such as fever, nausea, stomach pain and general fatigue. Post-embolization syndrome could be an inflammatory response to necrotic tissue, as the tumour is deprived of oxygen. Prophylactic treatments like dexamethasone-lipiodol can help reduce the occurrence of post-embolisation syndrome.
Non-target Embolization – There is a mild risk of embolic agents dislodging themselves and travelling through the bloodstream to unintended locations. This can result in a blockage somewhere else in the vascular network and deprive healthy tissues of oxygen. This is very rare and is usually not the case when the procedure is performed by an experienced radiologist. Careful imaging guidance and choosing an appropriate embolic agent reduce this risk significantly.
Infection – Minimally invasive procedures such as this one have very low chances of infection. There is a remote chance of an infection at the incision site. However, this is avoided through the use of a sterile environment and instruments, as well as hygienic dressings.
Pre-operative embolisation has a good success rate. In a study conducted in 2021, surgeons found that when pre-operative embolisation is performed before a partial nephrectomy, in cases with renal cell carcinoma, the patients were able to retain kidney function and recover more quickly. The procedure does this primarily by reducing blood loss. Advances in imaging technology and embolic agents have made the procedure safer and more useful in treating various diseases. The safety and effectiveness of the technique are responsible to making it a standard preparatory procedure for high-risk surgeries. In medicine, risk management is key and this procedure does exactly that. For patients suffering from cancer, this procedure is an important medical breakthrough in their care.
If you’re considering advanced treatments like pre-operative embolization, expert care is essential for the best outcomes. Kauvery Hospital offers cutting-edge interventional radiology and comprehensive cancer care across its branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy. Trust the experienced team at Kauvery Hospital to guide you through every step of your treatment journey with compassion and expertise.
What does pre-operative embolization do before cancer or tumor surgery?
Pre-operative embolization blocks blood vessels feeding a tumor. This helps reduce bleeding, makes surgery safer, and allows the surgeon to remove the tumor with better control.
Is pre-operative embolization really necessary before surgery?
It is necessary when a tumor has a high blood supply. Without embolization, surgery may involve more bleeding and longer operating time. Doctors recommend it only when it genuinely improves surgical safety.
How long does pre-operative embolization take, and what can I expect?
The procedure usually takes 1 to 3 hours. A small catheter is guided to the tumor’s vessels and embolic material is placed to block blood flow. Most patients feel mild discomfort, not major pain.
Is pre-operative embolization safe, and what are the risks?
It is generally safe when done by a trained interventional radiologist. Minor side effects like pain or fever may occur. Serious complications are rare and doctors monitor closely for safety.
How soon after embolization is surgery done?
Most surgeries happen within 24 to 72 hours. This timing allows the tumor’s blood supply to reduce but avoids unnecessary delays in treatment.
Does embolization help shrink the tumor before surgery?
Yes. Many tumors shrink slightly after their blood flow is blocked. This can make surgical removal easier and more precise.
Who benefits most from pre-operative embolization?
Patients with highly vascular tumors like brain, spinal, neck, kidney, or liver tumors benefit the most. Doctors assess scans to decide if embolization will improve surgical outcomes.
What should I avoid or prepare for before embolization?
Patients may need to stop certain medications, avoid eating for a few hours, and follow hydration guidelines. Your care team will give exact instructions based on your case.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet, Radial Road & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and paediatric trauma care.
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