Hypervascular tumors of the central nervous system (CNS), such as meningiomas, hemangioblastomas, and paragangliomas, are among the most difficult conditions for neurosurgeons to manage. Their dense vascular networks obscure tumor boundaries and increase the risk of severe bleeding and neurological damage. Conventional treatment relies on a two-stage process—embolization followed days later by resection—which can cause swelling, hemorrhage, and treatment delays. Now, a single procedure combines embolization and resection for safer outcomes in hypervascular CNS tumors.

Neurosurgeons at Beijing Tiantan Hospital (Beijing, China) have pioneered a one-stage hybrid surgery that combines embolization and tumor removal in a single procedure. The technique was evaluated in a decade-long clinical study involving 31 patients treated between 2014 and 2024. Conducted in a hybrid operating room equipped for both endovascular and open neurosurgical procedures, this approach enables seamless transition from embolization to resection during the same anesthesia session.

The hybrid method involves selective embolization of deep or surgically inaccessible arterial feeders while leaving superficial vessels for surgical management. Embolic materials included ethylene vinyl alcohol copolymer, detachable coils, and silk suture fragments, with balloon catheters occasionally used for temporary vascular control. Rather than aiming for complete blockage, the strategy reduces intraoperative bleeding while ensuring immediate tumor removal.

The study reported gross-total removal in 71 percent of cases, near-total removal in 19.4 percent, and partial removal in 9.7 percent. Intraoperative blood loss was on average more than one liter lower than that seen in staged procedures, and importantly, no embolization-related complications were observed. At discharge, 87 percent of patients had stable or improved neurological function, and two-thirds were symptom-free one year later.

These findings, published in the Chinese Neurosurgical Journal, suggest the hybrid approach not only minimizes risk but also improves efficiency in treating hypervascular CNS tumors. By integrating endovascular and surgical steps, operative time and patient stress are reduced. If validated in larger trials, this one-stage method could become the new standard for managing these high-risk conditions, offering safer and more effective outcomes compared to staged treatments.

“Our experience shows that the one-stage hybrid operation is both safe and effective for managing hypervascular CNS tumors,” said lead investigator Professor Yi Lu, while adding that although the study results were promising, larger prospective studies will still be needed to confirm its advantages over conventional staged treatments.

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