Preoperative tumour embolisation
Reviewed by Gentle Wong

This review article analyses the role of preoperative endovascular tumour embolisation in the treatment of a variety of hypervascular head and neck lesions including juvenile nasal angiofibroma, glomus tumour, carotid body tumours, and meningioma. Although the concept of tumour embolisation dates back several decades, this article provides a refreshing reminder and updates us with current improvements in catheter design, enhanced angiographic imaging capabilities, as well as novel embolic agents; all of these making endovascular intervention safer and easier. Despite its advances, the pertinent question to ask is not whether embolisation is feasible, but whether it is necessary. It is important to understand tumour hypervascularlity alone is not a good reason to subject the patient to the added risk of embolisation, especially if the tumour is small, and the major blood supply to the tumour is readily accessible early at surgery. On the other hand, if embolisation may decrease total operative time (and anaesthetic risk to the patient), or deal with surgically inaccessible arterial feeders, and improve visualisation at surgery thus facilitating tumour resection, then the appeal becomes apparent. In conclusion, as technology advances and more studies are conducted, embolisation will evolve to further complement (or substitute in some cases!) surgery. 

Preoperative tumour embolisation.
Ashour R, Aziz-Sultan A.
NEUROSURGERY CLINICS OF NORTH AMERICA
2014;25(3):607-17.