• Rami O Almefty, Nirav J Patel, Alfred P See, Ian F Dunn, Ossama Al-Mefty, and Mohammed Ali Aziz-Sultan.
• Department of Neurosurgery, Brigham and Women Hospital, Harvard School of Medicine, Boston, Massachusetts, USA; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA. Electronic address: rami.almefty@bnaneuro.net.
• World Neurosurg. 2017 Jun 1; 102: 157-166.

BackgroundGiant hypervascular intracranial tumors represent a formidable challenge because their size limits surgical control of the blood supply and debulking poses the risk of critical blood loss. Embolization facilitates resection but carries the risk of life-threatening tumor infarction, hemorrhage, or swelling if performed preoperatively. Endovascular intraoperative embolization avoids the fatal risk and allows the surgeon to attend instantly if any complication occurs.Methods And ResultsWe report 2 cases in which combining intraoperative embolization with microsurgical resection in the hybrid operating room was used to safely and successfully remove giant hypervascular tumors.ConclusionsIntraoperative embolization facilitates the safe resection of giant hypervascular tumors and mitigates the consequences of potential tumor infarction, hemorrhage, or swelling from embolization. These cases exemplify the benefits of combining expertise in endovascular and microsurgical techniques with the capabilities of modern hybrid operating rooms allowing for their simultaneous application.Copyright © 2017 Elsevier Inc. All rights reserved.

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