Hypervascularized Tumors

Hypervascularized tumors are characterized by having large numbers of blood vessels feeding them and are found in many locations, the most common being in the liver, the brain and its covering, and the uterus, and can also be found in the spine, the head and neck, the ovaries, and in the pancreas. Interventional Neuroradiologists embolize hypervascularized tumors of the brain, spine and head and neck prior to surgery to decrease blood loss and allow better visualization of the tumor during surgery. Surgery is usually performed 24 hours to one week after embolization, depending on the type and location of the tumor.

Literature related to Hypervascularized Tumors:

Peripheral Applications

• Liver Tumors
  Embolization of liver tumors can be indicated for the treatment of cancerous tumors that can be a result of colorectal metastases, hepatocellular carcinoma (HCC), Hepatitis C, Hepatitis B, and metastases from other parts of the body. There are two types of embolization that are used within the liver: bland embolization, which is embolization without chemotherapy; and chemoembolization, which is embolization in combination with chemotherapeutic drugs. The benefits and risks with both treatments are different with every patient; thus, it is important to talk to your oncologist, internventional radiologist, or referring physician about these therapies.

Cerebrovascular Applications

• Meningioma
  Meningiomas are typically benign vascular neoplasms on the covering of the brain and may cause symptoms by pressing on the underlying brain tissue. Meningiomas are usually embolized prior to surgery in order to minimize the amount of blood loss during surgery, as these slow growing tumors require a lot of blood supply and are parasitic in nature.

  Figure 1	Figure 2
  Click images for a larger view

  Figure Legend:
  These images are from an angiogram obtained by inserting a small catheter through a blood vessel in the groin and advancing it to the neck region. A radiologic dye, called "contrast", is injected into the blood stream, which allows the physician to see the location and configuration of blood vessels. Radiographic imaging is performed during the injection of "contrast", producing a form of "movie" called an angiogram or arteriogram. Blood vessels and hypervascularized tumors appear dark on angiograms.

  The arrows in figure 1 outline a hypervascularized tumor called a meningioma that arises from the covering of the brain. This image was obtained prior to embolization with Embosphere™ Microspheres. The arrows in figure 2 show the same area following embolization of the tumor with Embosphere Microspheres. The dark region representing the tumor is no longer seen as the tumor blood supply has been blocked. The patient safely underwent surgical removal of the meningioma several days following embolization.

• Paraganglioma
  Paragangliomas, also referred to as glomus tumors, may grow along the course of nerves in the head and neck region and are named according to their location (glomus tympanicum, glomus jugulare, glomus vagale, carotid body tumor). Paragangliomas are usually benign, hypervascularized tumors that usually cause symptoms such as hearing one's pulse in the ear (pulsatile tinnitus), facial pain or numbness, hoarse voice and difficulty swallowing. They can also present as a lump felt in the neck. More than one paraganglioma may be present in the same patient and occasionally, these tumors are malignant (cancerous). Paragangliomas are usually therefore removed during surgery, but embolization is often performed 2-3 days prior to surgery to block off tumor blood supply.
  
  
• Juvenile Nasopharyngeal Angiofibroma
  Juvenile nasopharyngeal angiofibromas (JNA) are benign, hypervascularized tumors that grow in the back of the nose and throat. They occur almost exclusively in teenage boys and often result in nosebleeds, which on occasion are severe, and may require hospitalization. JNA also may cause nasal stuffiness or symptoms of sinus infection, ear infections and loss of smell. These tumors can be quite large and typically require surgical removal. Embolization of the tumor blood vessels most often is performed prior to surgical removal.
  
  
• Head and Neck Cancer
  Cancer of the head and neck includes those tumors arising in the throat, tongue and back of the nose and mouth. These cancers may occasionally bleed and can result in significant blood loss. It may be difficult to control the bleeding with surgery and embolization is therefore performed to stop the bleeding.

Investigational Study

• Uterine Fibroids
  There are two specific clinical trials underway in the United States where embolization is being utilized to treat these patients. These trials are comparing embolization versus the traditional treatment methods of hysterectomy or myomectomy. The embolic products used in these trials are considered to be investigational devices for this indication and are limited by federal law to investigational use for embolization of uterine fibroids. For more information, please contact an IR near you.

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Embosphere® Microspheres and EmboGold™ Microspheres Indications:

1. Embolization of hypervascularized tumors.
2. Embolization of arteriovenous malformations (AVM).

We would like to acknowledge and thank Dr. Bob White and Dr. Jeff Stone for their contributions to the content of this website.

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Controlled, Targeted Embolization

BioSphere Medical's microspheres are precisely calibrated, spherical, hydrophilic, micro-porous beads made of an acrylic co-polymer (trisacryl) which is then cross-linked with gelatin. This proprietary and patented design allows a more complete and targeted occlusion of the blood vessels feeding a hypervascularized tumor or arteriovenous malformation. Furthermore, the hydrophilic surface and spherical shape prevent aggregation within the catheter lumen and in the vasculature, promoting ease and accuracy of delivery. Finally, the elastic properties of the microspheres also allow the temporary deformation of the sphere, which facilitates the passage through small delivery systems.

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Embosheres: Flexible spheres Non Aggregating Uniform occlusion Predictable penetration	PVA: Irregular shape Clumping Non-uniform occlusion More proximal occlusion

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Compressible and Hydrophilic: Elastic shape and hydrophilic surface prevent aggregation within the catheter, simplifying handling and promoting accurate delivery to the target vessel.

Preparation and Administration
One of the major benefits to Embosphere® Microspheres and EmboGold™ Microspheres is the packaging design which allows ease of use. In order to leverage the benefits derived from the packaging, it is important to follow some very simple preparation and administration steps. Please contact your local sales representative to schedule an in-service with one of our clinical specialists.

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