The hybrid operation of a stage improves safety in hypervascular brain treatment and spinal tumors

Hypervascular tumors of the brain and spinal cord pose serious challenges for neurosurgeons due to their dense nets of blood vessels, which can cause strong bleeding and greater surgical risk. In a new study of a decade, Beijing Tiantano researchers demonstrated that performing endovascular embolization and micro -surgical elimination in a single session known as a hybrid operation of a stage, can improve surgical safety, reduce blood loss and maintain neurological results in patients.

Hypervascular tumors of the central nervous system (CNS) such as meningiomas, hemangioblastomas and paragangliomas are known for their rich blood supply, which can obscure tumor limits and increase the risk of neurological lesions during surgery. Traditionally, these tumors are treated in two stages: Preoperative embolization to block blood flow, followed days later by eliminating the tumor. While it is effective in some cases, this staging approach can lead to complications, including swelling, bleeding and delays between treatments.

A research team led by Professor Yi Lu, reviewed 31 cases treated between 2014 and 2024. This document was published on July 31, 2025, in volume 11, article 14 in the Chinese neurocuríic magazine. Patients were ages of age from young adults to older people, with tumors located in challenging areas such as the base of the skull, cerebellum and brainstem. The elimination of Gross-Total tumors was achieved in 71% of patients, with almost total elimination in 19.4% and partial elimination in 9.7%. The average blood loss was 1,127 ml lower than typical staging cases and no complications related to embolization occur. At discharge, 87% of patients had stable or improved neurological function, already 12 months, two thirds were free of symptoms. Professor Yi Lu explained: “There is an urgent need for an innovative solution that can achieve both vascular obliteration and the elimination of complications.”

The embolization strategy focused on deep or surgically inaccessible arterial feeders, leaving the superficial vessels that will be handled during surgery. This selective approach helped avoid damage to normal brain vessels and reduced the risk of ischemic complications. Materials such as the ethylene vinyl alcohol copolymers (Evoh), removable coils and silk suture segments for the closure of directed vessels, and in certain cases, balloon catheters provided balloon catheters provided temporary blood flow control during craneotomy control during the craniotomy. Unlike traditional preoperative embolization, the objective was not the total blockade of the vessels, but the strategic reduction of the risk of bleeding during immediate resection.

The hybrid method of a stage integrates both procedures in a single operation, carried out in a specialized hybrid operating room equipped for endovascular and open neurosurgery. This configuration allows surgeons to block the tumor blood vessels difficult to reach and proceed directly to resection under the same anesthesia, reducing the time, risk and stress of the patient.

“Our experience suggests that the hybrid operation of a stage is safe for the treatment of hypervascular CNS,” said Professor Li. The researchers point out that, although the results are promising, larger prospective studies are needed to compare this method directly with the stages treatment. If they are validated, the hybrid approach to a stage could become a new standard to manage high -risk CNS tumors.