Preoperative Embolization of Cerebellar Hemangioblastomas with a Liquid Embolic Material (NBCA) by the "Plug and Push" Technique

[Objective]: We retrospectively reviewed patients who had undergone preoperative embolization of cerebellar hemangioblastomas with a liquid embolic material, n-butyl-2-cyanoacrylate (NBCA), by the plug and push technique. [Methods]: The subjects were six patients who had undergone preoperative embolization of cerebellar hemangioblastomas in our hospital between April 2016 and October 2017. In all patients, a microcatheter was selectively guided into a feeder, and tumor embolization with low-concentration NBCA, which had been diluted with oily contrast medium, was performed using the plug and push technique before tumor resection based on approval by the Ethics Review Board of our hospital. [Results]: The male-to-female ratio was 5:1. The mean age was 33.8 +- 10.7 years. The tumor type was evaluated as nodular in three patients and solid in three patients. The mean nodular size was 26 +- 8.9 mm. The mean interval from embolization until surgery was 1.3 days (1-4 days). In all patients, the procedure could be accomplished. The mean concentration of NBCA was 19.4% +- 1.4%. Concerning the embolization effects, cerebral angiography showed complete occlusion in four patients and partial occlusion in two patients. There was no embolization-related complication or adverse event. Under suboccipital craniotomy, total tumor resection was possible in five patients, whereas one patient required blood transfusion. [Conclusion]: Preoperative embolization of cerebellar hemangioblastomas with low-concentration NBCA by the plug and push technique may be useful for accomplishing tumor resection although catheter adhesion on infusion must be considered.