Neurosurgeons integrate endovascular embolization and tumor resection for safer, more effective treatment
Hypervascular tumors of the brain and spinal cord pose serious challenges for neurosurgeons due to their dense blood vessel networks, which can lead to heavy bleeding and increased surgical risk. In a new decade-long study, researchers at Beijing Tiantan Hospital demonstrated that performing endovascular embolization and microsurgical removal in a single session known as a one-stage hybrid operation, can improve surgical safety, reduce blood loss, and maintain neurological outcomes in patients.
Hypervascular central nervous system (CNS) tumors such as meningiomas, hemangioblastomas, and paragangliomas are known for their rich blood supply, which can obscure tumor boundaries and increase the risk of neurological injury during surgery. Traditionally, these tumors are treated in two stages: preoperative embolization to block blood flow, followed days later by tumor removal. While effective in some cases, this staged approach can result in complications, including swelling, hemorrhage, and delays between treatments.
A research team led by Professor Yi Lu, reviewed 31 cases treated between 2014 and 2024. This paper was published on July 31, 2025, in Volume 11, Article 14 in
Chinese Neurosurgical Journal. Patients ranged in age from young adults to seniors, with tumors located in challenging areas such as the skull base, cerebellum, and brainstem. Gross-total tumor removal was achieved in 71% of patients, with near-total removal in 19.4% and partial removal in 9.7%. The average blood loss was 1,127 mL lower than typical staged cases and no embolization-related complications occurred. At discharge, 87% of patients had stable or improved neurological function, and at 12 months, two-thirds were symptom-free. Professor Yi Lu explained,
“There is an urgent need for an innovative solution that can achieve both vascular obliteration and elimination of complications”.
The embolization strategy focused on occluding deep or surgically inaccessible arterial feeders, leaving superficial vessels to be managed during surgery. This selective approach helped avoid damage to normal brain vessels and reduced the risk of ischemic complications. Materials such as ethylene vinyl alcohol copolymer (EVOH), detachable coils, and silk suture segments were used for targeted vessel closure, and in certain cases, balloon catheters provided temporary blood flow control during craniotomy. Unlike traditional preoperative embolization, the aim was not total vessel blockage, but strategic reduction of bleeding risk during immediate resection.
The one-stage hybrid method integrates both procedures into a single operation, performed in a specialized hybrid operating room equipped for both endovascular and open neurosurgery. This setup enables surgeons to block hard-to-reach tumor blood vessels and proceed directly to resection under the same anesthesia, reducing time, risk, and patient stress.
“Our experience suggests that one-stage hybrid operation is safe for the treatment of hypervascular CNS,” said Professor Li. The researchers note that while results are promising, larger prospective studies are needed to compare this method directly with staged treatment. If validated, the one-stage hybrid approach could become a new standard for managing high-risk CNS tumors.
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References
Title of original paper: One-stage hybrid operation for hypervascular central nervous system tumors: a single-center experience of 31 cases
Journal: Chinese Neurosurgical Journal
DOI: https://doi.org/10.1186/s41016-025-00400-y