Preoperative transarterial Embolisation in bone tumors

Bone tumors include a variety of lesions, both primary and metastatic. The treatment modalities for bone tumors vary with the individual lesion, but in general surgical excision is the treatment of choice with other adjunctive therapies. However, surgery for many bone tumors is complex due to several factors including tumor bulk, vascularity, vicinity to vital structures and potentially inaccessible location of the lesion. Transarterial Embolisation (TAE) is one of the important adjuvant treatment modalities and in some cases it may be the primary and curative treatment. Preoperative TAE has proved to be effective in both primary and metastatic bone tumors. It reduces tumor vascularity and intraoperative blood loss, the need for blood transfusion and associated complications, allows better definition of tissue planes at surgery affording more complete excision, and hence reduced recurrence. Preoperative chemoEmbolisation has also been shown to increase the sensitivity of some tumors to subsequent chemotherapy and radiotherapy. There are several techniques and embolic agents available for this purpose, but the ultimate aim is to achieve tumor devascularization. In this review, we discuss the techniques including the choice of embolic agent, application to individual lesions and potential complications.     

Development of right transverse sinus dural arteriovenous malformation after embolisation of a similar lesion on the left

We present a patient in whom a transverse sinus dural arteriovenous malformation developed after successful endovascular embolisation of a similar lesion on the contralateral side.     

Superselective angiography,embolisation and surgery in treatment of arteriovenous malformations of the brain

We prospectively evaluated a diagnostic and therapeutic procedure combining superselective, angiography, endovascular embolisation and surgery in arteriovenous malformations (AVM) of the brain. Our aim was to achieve the best possible result exposing the patients to the lowest possible risk. During a 3 year period 48 patients were studied, of whom 22 (46%) were treated by incomplete preoperative embolisation and subsequent complete surgical removal of the AVM. All angiography and embolisations were performed with the Tracker catheter system using polyvinyl alcohol particles and/or platinum fibre coils. The other 26 patients were treated as follows: incomplete embolisation in 11 (23%), complete embolisation in 2 (4%), angiography and surgery in 3 (6%) and combined embolisation and radiation in 7 (15%), 3 patients were excluded from any therapy after superselective angiography. The total number of acute complications and permanent sequelae were 8 (17%) and 3 (6%) respectively. We concluded that superselective cerebral angiography, a relatively safe procedure, should play an impotant role in deciding treatment strategies for AVMs of the brain. The risks of combined embolisation and surgery are probably lower than those of either alone. In a few cases surgery or embolisation alone carries an unequivocally lower risk, and combined therapy is not justifiable.     

胶囊阻塞法经皮经肝总动脉作肝栓塞术

本文报道了12例胶囊阻塞法经皮经肝总动脉作肝栓塞的病例,介绍了这一新技术的具体操作方法,该技术的特点在于导管在肝总动脉水平便可作肝栓塞治疗,而不致胃十二指肠动脉栓塞,从而使得肝固有动脉超选择插管不能的肝肿瘤患者行肝栓塞成为可能。本文对2例典型病例进行了详细介绍,还就该技术的作用机理、安全性及使用价值等作了讨论。     

Subselective embolisation in management of JNA

Role of Embolisation in preoperative management of Nasopharyngeal angiofibroma is well established in present day therapeutic modalities. An improvised technique i.e., subselective embolisation has been provided by Interventional radiologists to fortify the therapeutic results. This study compares the final outcome of seven cases, four of which were embolised pre operatively. Each case was dealt with varying surgical approaches.     

Prise en charge initiale en réanimation des traumatisés graves du bassin

Pelvic trauma care is complex since it is frequently associated with multiple injuries and may lead to dramatic and uncontrollable haemorrhage. After pelvic trauma, the mortality, around 8 to 10%, is mainly related to severe pelvic hemorrhage but also to extrapelvic injuries (thoracic, abdominal or brain injuries). It is therefore crucial to manage pelvic trauma in specialized trauma center. The initial trauma assessment aims to determine the role of the pelvic injury in hemorrhage to define the therapeutic strategy of pelvic trauma care (arterial embolisation/pelvic ring stabilisation). This review was performed with a systematic review of the literature; it describes the pelvic fracture pathophysiology, and the efficacy and safety of haemostatic procedures and with their respective indications. A decision making algorithm is proposed for the treatment of trauma patients with pelvic fracture.     

Interdisciplinary management of mandibular intraosseous haemagioma

Intraosseous haemagiomas usually occur in the vertebral column, and are rare in the facial bones. Mandibular intraosseous haemangioma makes up less than 1% of all intraosseous tumours. We describe here the presentation, diagnosis, treatment, and outcome in a 15-year-old boy who presented with a mandibular intraosseous haemangioma. He was treated by embolisation, en bloc resection, and immediate replacement of the mandibular segment. We also harvested the proximal tibia bone grafts and inserted four dental implants. He is well 3 years later.     

Uterine necrosis following pelvic arterial embolisation for postpartum haemorrhage: Case report

We report a case of uterine necrosis in a 38 year-old patient, who underwent a caesarean section for placenta praevia and an embolisation of the uterine arteries for postpartum haemorrhage. The pelvic embolisation was performed with absorbable gelatine sponge pledgets. This woman presented with abdominal pain and fever three weeks after delivery and a computed tomography scan revealed the presence of gas in the myometrium and endometrium and allowed the diagnosis of uterine necrosis. A total abdominal hysterectomy was performed with adnexal conservation and the diagnosis of uterine necrosis was confirmed histologically. The complications of pelvic embolization and the risks of surgical procedures for the management of intractable obstetric hemorrhage are described.