Feasibility and risks of preoperative embolization for CNS hemangioblastoma surgery at a national VHL referral center
- 1Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- 2Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- 3Department of Neurosurgery and Spine Surgery, Klinikum Main-Spessart, Lohr Am Main, Germany
Abstract
Introduction: Preoperative embolization is used selectively for central nervous system hemangioblastomas (CNS HBLs), but anatomical feasibility and procedural risk remain important uncertainties.
Research question: How feasible is embolization in selected CNS HBL cases?
Material and methods: We retrospectively reviewed a prospectively maintained von Hippel-Lindau (VHL)/HBL registry (1997–2025), including operations preceded by angiography with intent to embolize. Feasibility, operator-reported devascularization, complications, and perioperative outcomes were assessed. Devascularization was categorized into “non-feasible”, <50%, 50–75%, and >75%. Comparisons were exploratory.
Results: We identified 237 individuals, 565 operations, and 804 CNS-HBLs. Twenty-seven (4.8%) procedures met inclusion criteria. Embolization was performed in 21/27 cases (77.8%; 95% CI 57.7–91.4%), with >75% devascularization in 13/21 (61.9%). Prohibitive vascular anatomy prevented embolization in six cases. Four angiography-related complications occurred (4/27 overall: 14.8%, 95% CI 4.2–33.7%; 4/21 embolization: 19.0%, 95% CI 5.4–41.9%), including two with permanent neurological deficits. In embolized versus non-feasible cases, median surgery duration was 271 versus 372 min, median blood loss was 425 versus 600 mL, median hemoglobin decrease was 2.6 versus 4.1 g/dL, and functional status improved/remained unchanged/worsened in 10/9/2 versus 0/3/3 cases, respectively. Qualitative bleeding assessments did not differ.
Conclusions: Only a small proportion of CNS HBLs were considered for preoperative embolization. Embolization was feasible in most selected cases but carried relevant procedural risk. The small cohort, and potential confounding prevent attribution of outcome differences to embolization. Careful multidisciplinary selection in high-volume VHL/HBL centers remains essential. Future studies would benefit from standardized angiographic scoring systems and uniform criteria for assessing embolization success.
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BibTeX
@article{doriamedina2026feasibility,
title = {{Feasibility and risks of preoperative embolization for CNS hemangioblastoma surgery at a national VHL referral center}},
author = {Roberto Doria-Medina and Nicolas Neidert and Marc Hohenhaus and Alexander Rau and Ikram Eda Duman Kavus and Samer Elsheikh and Christian Taschner and Jürgen Beck and Jan-Helge Klingler and Christine Julia Gizaw},
journal = {Brain \& Spine},
year = {2026},
month = oct,
doi = {10.1016/j.bas.2026.107475},
url = {https://doi.org/10.1016/j.bas.2026.107475},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Feasibility and risks of preoperative embolization for CNS hemangioblastoma surgery at a national VHL referral center
AU - Roberto Doria-Medina
AU - Nicolas Neidert
AU - Marc Hohenhaus
AU - Alexander Rau
AU - Ikram Eda Duman Kavus
AU - Samer Elsheikh
AU - Christian Taschner
AU - Jürgen Beck
AU - Jan-Helge Klingler
AU - Christine Julia Gizaw
PY - 2026
DA - 2026/10/12
JO - Brain & Spine
DO - 10.1016/j.bas.2026.107475
UR - https://doi.org/10.1016/j.bas.2026.107475
AB - Introduction: Preoperative embolization is used selectively for central nervous system hemangioblastomas (CNS HBLs), but anatomical feasibility and procedural risk remain important uncertainties. Research question: How feasible is embolization in selected CNS HBL cases? Material and methods: We retrospectively reviewed a prospectively maintained von Hippel-Lindau (VHL)/HBL registry (1997–2025), including operations preceded by angiography with intent to embolize. Feasibility, operator-reported devascularization, complications, and perioperative outcomes were assessed. Devascularization was categorized into “non-feasible”, <50%, 50–75%, and >75%. Comparisons were exploratory. Results: We identified 237 individuals, 565 operations, and 804 CNS-HBLs. Twenty-seven (4.8%) procedures met inclusion criteria. Embolization was performed in 21/27 cases (77.8%; 95% CI 57.7–91.4%), with >75% devascularization in 13/21 (61.9%). Prohibitive vascular anatomy prevented embolization in six cases. Four angiography-related complications occurred (4/27 overall: 14.8%, 95% CI 4.2–33.7%; 4/21 embolization: 19.0%, 95% CI 5.4–41.9%), including two with permanent neurological deficits. In embolized versus non-feasible cases, median surgery duration was 271 versus 372 min, median blood loss was 425 versus 600 mL, median hemoglobin decrease was 2.6 versus 4.1 g/dL, and functional status improved/remained unchanged/worsened in 10/9/2 versus 0/3/3 cases, respectively. Qualitative bleeding assessments did not differ. Conclusions: Only a small proportion of CNS HBLs were considered for preoperative embolization. Embolization was feasible in most selected cases but carried relevant procedural risk. The small cohort, and potential confounding prevent attribution of outcome differences to embolization. Careful multidisciplinary selection in high-volume VHL/HBL centers remains essential. Future studies would benefit from standardized angiographic scoring systems and uniform criteria for assessing embolization success.
SN - 2772-5294
ER -