Cerebral Tumour Embolisation

Tumour embolisation refers to the process of blocking or reducing the blood supply to a tumour. Chemoembolisation is less common, and refers to direct administration of chemotherapy into the blood vessels supplying a tumour.

Embolisations are carried out to reduce bleeding from the tumour during surgery. In an embolisation, special glue-like liquid is injected into the tumour in order to cut off blood supply. If a tumour is particularly large or complex or is very vascular (has a large blood supply), an embolisation may be completed prior to further surgical excision (removal) of the lesion, in order to reduce blood flow to the tumour and ensure further treatment is safer.

All treatments and procedures have risks and we will talk to you about the risks of having a tumour embolisation. Sometimes it is not possible to embolise a tumour safely. The procedure will need to take place under a general anaesthetic; the anaesthetist will discuss the risks of general anaesthesia with you.

Problems that may happen straight away

During a tumour embolisation, a contrast agent will be injected into your arteries; this allows the Interventional Neuroradiologist (INR) to see the blood vessels supplying the tumour when an X- ray is taken. Contrast agents are safe drugs; however as with all drugs, they have the potential to cause an allergic reaction.

The department and team are well equipped to deal with reactions in the rare event of this happening.

Problems that may happen later

The contrast agent used during a tumour embolisation is iodine based contrast and is excreted through the kidneys. Rarely this may affect your kidney function. You will have a blood test to test your kidney function beforehand to ensure it is safe for you to have contrast. The risk of you having contrast will be weighed against the benefit of having this treatment and is decided by the team referring you for an embolisation. For further information on the use of iodine based contrast agents please see the information leaflet ‘Contrast Agents for X-ray, Fluoroscopy, CT and Angiography Examinations: An Information Guide’ or alternatively visit the trust website.

Problems that are rare, but serious 

Tumour embolisations are difficult and complex procedures: serious complications are unlikely, but are always present. Like all procedures involving the blood vessels of the brain, a tumour embolisation carries a risk of stroke which results from either a blockage of a blood vessel or from a haemorrhage. This can range from a minor problem which improves over time to a severe disability involving movement, balance, speech or vision or may even be a threat to life. The percentage level of this risk is low, but can only really be discussed on a case by case basis and depends on size and position of the tumour itself.

Other Problems that occur

Haematoma, bruising or vessel damage around the groin or wrist puncture site may also occur. Usually a stitch is placed in the femoral artery (in the groin) after the tube has been removed to stop the bleeding. If the wrist (radial artery) is used for access, a compression band will be applied to the wrist after the procedure. Often there is bruising, and less often bleeding. It is rarely serious but can go on for a few hours if unnoticed. Very occasionally there is damage to the blood vessel requiring a further surgical operation.

Any problem is usually apparent during or immediately after the procedure, or during the next few days whilst you are still in hospital.

Radiation Risk

The use of X-rays during the procedure presents a very small risk of hair loss, skin erythema (reddening) or very rarely the development of cancers in the future. Our state of the art imaging equipment and modern techniques ensure the radiation dose is as low as possible. In addition, your doctor will have made a judgement about your risk and benefit before agreeing to the procedure (including the risk to your health of not having the procedure).

Patients of child bearing capacity between the ages of 12 and 55 years are required by law to be asked about possible pregnancy when undergoing examinations involving x-ray. Patients who either are, or think they may be pregnant must inform the Neuroradiology Department as soon as possible. In some urgent cases the procedure may still go ahead but with additional precautions in place. To reduce the risk for early and unknown pregnancies, tumour embolisations are usually performed within the first ten days of the menstrual cycle when pregnancy is much less likely.

The Interventional Neuroradiologist performing the procedure will discuss all possible risks with you and give you the opportunity to ask questions.

If we think you will benefit from embolisation of your tumour we will offer you this procedure, the final decision whether or not to have this procedure is entirely yours. To decline the procedure will not affect your personal care. However, it may mean that your doctor cannot be as certain or specific about any future treatment or procedures and it may affect some clinical decision making.

As mentioned previously tumours can be treated by multiple methods like chemoembolisation and surgical excision, which endovascular treatments (tumour embolisations) as explained in this leaflet can assist with.

Surgical excision

This involves a craniotomy, or creating an opening in the skull to allow the Neurosurgeon to surgically remove the lesion.

As with tumour embolisations, the alternatives carry their own specific risks and your Neurosurgeon will discuss these in detail with you. If you are unsure about the treatment you are due to receive do not hesitate to speak with your referring doctor.

You will be asked to arrive at the hospital the day before or on the morning of your procedure. If you are arriving the morning of your procedure you will be asked to arrive at 8am to the surgical reception unit (SRU) or to the ward specified by the admission officer in contact with you. Your procedure may take place at any time during the day due to emergency cases, but we will endeavour to keep you informed and perform your procedure as early in the day as possible.

The procedure is performed by specialist doctors called Interventional Neuroradiologists (INR). The INR will see you on the ward to explain the procedure and any associated risks. Please feel free to ask any questions at this time.

The procedure is performed under a general anaesthetic (this means you will be unconscious or ‘asleep’ throughout). Your anaesthetist will talk to you about the anaesthetic, and what you can expect when having a general anaesthetic both in clinic before the procedure and again briefly on the ward the day of your procedure. You will need to fast for six hours before your procedure. Your anaesthetist will confirm with you a specific time you must stop eating and drinking. You should still take all of your medications at the normal times throughout this period with a sip of water, unless advised otherwise.

You will be asked to change into a hospital gown and disposable underwear. A member of staff, usually the nurse caring for you, will accompany you to the radiology department.

It is important that you are involved in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves. Staff will explain all the risks, benefits and alternatives before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please don’t hesitate to speak with a senior member of staff.

The tumour embolisation is performed while you are under general anaesthetic. The anaesthetic team will put you to sleep in the anaesthetic room prior to transfer to the angiography suite.

The procedure is performed by the INR in the angiography suite (operating theatre) located in the radiology department. It usually takes between one and three hours. A dedicated team of radiologists, radiographers, anaesthetists and nurses will be in the angiography suite to monitor you closely throughout the procedure.

Once the procedure has commenced, the INR will place a thin, flexible, plastic tube (catheter) into the femoral artery in the groin or radial artery in the arm. The catheter passes through the main artery in the body called the aorta and finally into the arteries in your brain. Before the embolisation begins the INR will inject the cerebral arteries to confirm the best approach into the tumour, a contrast agent will be injected which will allow the blood vessels and the lesion to be seen when an x-ray is taken.

When an accessible feeding artery is identified the catheter is placed into this feeding artery. Following this a second micro catheter is inserted inside the first. This micro catheter is placed directly into artery supplying blood to the tumour. Embolic material (glue like material) is then injected to seal off and obliterate this vascular supply. Occasionally small metal coils or permanent balloons will be used too. This embolic material creates an artificial blood clot or blockage to stop blood flowing into the tumour.

Further x-rays will be taken to ensure the tumour blood supply has been obliterated as much possible. Once the INR is satisfied with the result, the catheters are removed and the blood vessel in the groin or arm is sealed with a stitch / pressure band respectively.

After the procedure you will spend some time in the recovery unit or high dependency unit (HDU) before being transferred back to your ward. These units provide a high level of monitoring. You will be on bed rest for at least a few hours following the procedure to ensure the entry site of the catheter in your groin or arm begins to heal and that you are neurologically stable.

Some patients will then have a few days in hospital recovering before going back to main theatres for the removal or excision of their tumour.

You may also experience some pain or bruising at your groin or arm, depending where the catheter was placed, this should reduce over a few days.

For any non-urgent questions or concerns you may have following your procedure, please contact the Neurovascular Clinical Nurse Specialists.

The Brain & Spine Foundation UK

0808 808 1000

https://www.brainandspine.org.uk/our-publications/booklets/vascular-malformations-of-the-brain/

UCLH cannot accept responsibility for information provided by other organisations.

Lysholm Department of Neuroradiology

National Hospital of Neurology and Neurosurgery

Queen Square

London

WC1N 3BG

Email: uclh.referrals.neurorad@nhs.net

Direct line: 020 344 83444

Switchboard: 020 3456 7890

Extension: 83444 / 83446

Fax: 020 344 84723

Website: www.uclh.nhs.uk/nhnn

Neurovascular Clinical Nurse Specialists

National Hospital for Neurology and Neurosurgery

Queen Square

London

WC1N 3BG

Direct line: 020 344 83523

Switchboard: 020 3456 7890

Extension: 83523

Email: uclh.neurovascularnurse@nhs.net

Website: www.uclh.nhs.uk/nhnn

The Lysholm Department of Neuroradiology reception is located in Chandler wing, on the lower ground floor of the National Hospital for Neurology & Neurosurgery, Queen Square.

Please turn left when you exit the Chandler wing lifts on the lower ground floor to find our main departmental reception.