Pre-op Devascularisation of an Intraventricular Haemangioblastoma

Professor Jeffrey P. Kochan, MD
Associate Professor of Radiology and Neurosurgery, Temple University Hospital Philadelphia, USA

Patient History

  • 22-year-old male with history of two-week diplopia.
  • MRI revealed coincidental finding of large densely hypervascular mass in the fourth ventricle supplied by multiple distal branches of the right posterior-inferior cerrebellar artery (PICA).
  • No other focal neurological findings apparent, other than mild divergent gaze after sedation.
Bead Block Case 4 fig 1

Coronal post-gadolinium

Bead Block Case 4 fig 2

Sagittal pre-gadolinium

 

Procedure

  • Tumour embolised using Bead Block™ 100-300μm through a microcatheter, advanced distally through a 4Fr vertebral catheter into the left posterior cerebellar artery.
  • Infusion discontinued when normal distal left PICA arterial anatomy was visualised.
  • After embolisation a small residual trunk of vessel was satisfactorily coiled with two .010” liquid platinum microcoils.
  • Post-embolisation angiography showed significant reduction of approximately 80% in tumour neovascularity from each of the PICAs.
  • No change to neurologic examination or dysconjucate gaze post-embolisation.

Outcome

  • Satisfactory embolisation of bilateral PICA supply to an intra-fourth ventricular hypervascular mass.
Bead Block Case 4 fig 3

Pre-embolisation: right vertebral artery

Bead Block Case 4 fig 4

Pre-embolisation: left vertebral artery

 

Bead Block Case 4 fig 5

Pre-embolisation, lateral view: right vertebral artery

Bead Block Case 4 fig 6

Pre-embolisation, lateral view: left vertebral artery

 

Bead Block Case 4 fig 5

Post-embolisation: left vertebral artery

Bead Block Case 4 fig 8

Post-embolisation, lateral view: left vertebral artery

Regulatory notices and product safety data

Worldwide (excluding USA)

Bead Block™ is CE marked and indicated for the treatment of a variety of hypervascular tumours (including Uterine Fibroids) and arteriovenous malformations (AVMs). Bead Block™ may not be indicated for the treatment of Uterine Fibroids in your country, please check with your local distributor. For full prescribing information please refer to Bead Block instructions for use.

USA

Bead Block is intended to be used for the embolization of hypervascular tumors and arteriovenous malformations (AVMs)

Bead Block Cautions:

  • Do not use if the syringe or packaging appear damaged
  • Sterile and single use product.  Do not reuse
  • Select the size and quantity of Bead Block microspheres appropriate for the pathology to be treated
  • Embolization with Bead Block microspheres should only be performed by physicians who have received appropriate interventional occlusion training in the region intended to be embolized

For instructions for use, please refer to www.biocompatibles.com/beadblock-ifu

Bead Block Potential Complications:

  • Undesirable reflux or passage of Bead Block into normal arteries adjacent to the targeted lesion or through the lesion into other arteries or arterial beds, such as the internal carotid artery, pulmonary, or coronary circulations
  • Pulmonary embolization
  • Ischemia at an undesirable location
  • Capillary bed saturation and tissue damage
  • Ischemic stroke or ischemic infarction
  • Vessel or lesion rupture and haemorrhage
  • Neurological deficits including cranial nerve palsies
  • Vasospasm
  • Death
  • Recanalization
  • Foreign body reactions necessitating medical intervention
  • Infection necessitating medical intervention
  • Clot formation at the tip of the catheter and subsequent dislodgement