In the intricate and high-stakes realm of neurosurgery, treating hypervascular tumors within the central nervous system (CNS) presents enduring challenges that continue to push the limits of surgical innovation and patient safety. These tumors, which include meningiomas, hemangioblastomas, and paragangliomas, are distinguished by their dense, complex vascular networks. These vascular webs not only obscure critical tumor margins but substantially heighten the risk of significant intraoperative bleeding and neurological injury, demanding highly sophisticated management strategies. Until recently, the prevailing approach to address these tumors involved a staged treatment protocol: embolization to reduce blood supply followed days later by microsurgical tumor removal. However, this traditional two-stage method introduces potential hazards, such as increased risk of cerebral edema, hemorrhagic complications, and procedural delays that can compound patient morbidity.
A translational leap in this field emerges from a decade-spanning clinical investigation at Beijing Tiantan Hospital, where neurosurgeons have pioneered a one-stage hybrid procedure that amalgamates embolization and microsurgical resection within a single operative session. This innovative approach, tested on 31 patients over ten years, represents a transformative shift from conventional practice by leveraging hybrid operating rooms equipped with advanced imaging and interventional technologies. Through this consolidated surgical endeavor, the team demonstrated tangible improvements in surgical precision, reduced blood loss, and enhanced neurological outcomes, culminating in a published study in the Chinese Neurosurgical Journal in mid-2025.
Central to the technique is the nuanced application of selective embolization focused meticulously on deep arterial feeders embedded within the tumor’s core or otherwise inaccessible by surgical means. Unlike prior approaches predicated on near-complete vessel occlusion, this method emphasizes targeted embolic agent deployment—utilizing ethylene vinyl alcohol copolymer (EVOH), detachable coils, and silk suture fragments—to partially but effectively reduce tumor perfusion. Strategic preservation of superficial vessels for subsequent surgical management under direct visualization allows the neurosurgeon to better control bleeding intraoperatively. This hybrid strategy mitigates the inherent risks of delayed embolization yet offloads excessive devascularization stress from the subsequent resection phase.
The procedural advantage conferred by employing this single-stage hybrid operation thrives on the seamless integration of endovascular and open surgical techniques within hybrid operating rooms. These specialized environments combine state-of-the-art angiographic imaging with the sterility and access required for craniotomy, enabling the surgical team to transition fluidly between embolization and tumor excision without repositioning or repeated anesthesia. Balloon catheters may be introduced selectively to temporally occlude critical arteries, optimizing the operative field for tumor resection and minimizing intraoperative transfusion requirements.
Quantitatively, the study’s results speak volumes about the potential paradigm shift offered by one-stage hybrid operations. Gross-total tumor resection was attained in 71 percent of patients, demonstrating the technique’s efficacy in achieving surgical completeness critical for long-term disease control. Additionally, 19.4 percent of cases yielded near-total resections, while partial tumor removal was necessary in only a minority (9.7 percent). Perhaps most strikingly, average intraoperative blood loss dropped by over one liter compared to historical data on staged procedures, suggesting a marked reduction in hemodynamic instability and associated complications. Importantly, the study noted zero embolization-related adverse events, underlining the safety profile of the one-stage approach.
Neurological outcomes further corroborate the clinical promise of this optimized intervention. By the point of hospital discharge, 87 percent of patients exhibited stable or improved neurological function, a critical benchmark for quality of life post-surgery. Moreover, the 12-month follow-up revealed that approximately two-thirds of patients were symptom-free—a remarkable testament to the durability and therapeutic impact of this single-session intervention. These outcome metrics not only underscore the functional benefits but also hint at possible reductions in post-surgical rehabilitation durations and healthcare resource utilization.
The technical philosophy underpinning the hybrid operation diverges from previous embolization strategies that sought absolute vessel occlusion, which often resulted in tumor swelling or vascular complications in the interprocedural interval. The measured embolization approach aims to decrease tumor blood supply just enough to facilitate safer tumor dissection while avoiding ischemic insult to surrounding neural tissue. This is achieved through the judicious deployment of embolic materials chosen for their biocompatibility and controllability—EVOH’s cohesive polymerization and detachable coils’ mechanical occlusion provide complementary modalities tailored to specific vessel calibers and configurations.
From a practical standpoint, executing this complex operation demands multidisciplinary coordination and state-of-the-art operative infrastructure. The adoption of hybrid operating rooms signifies a crucial enabler, integrating fluoroscopic guidance systems, catheterization suites, and microsurgical tools within a single sterile environment. This convergence minimizes patient transfer risks, accelerates intervention times, and streamlines perioperative management. The Beijing Tiantan team’s experience illustrates how such infrastructural investments, paired with refined surgical protocols, can enhance both clinical efficacy and patient safety.
In evaluating the broader implications, this decade-long single-center experience offers a compelling case for rethinking the standard of care in hypervascular CNS tumor management. By reducing operative risk, condensing treatment timelines, and improving neurological outcomes, the one-stage hybrid operation has the potential to become a new surgical gold standard. Nonetheless, the authors prudently emphasize the necessity for larger prospective, multicenter trials to corroborate these findings and further delineate patient selection criteria, optimal embolization endpoints, and long-term sequelae.
Despite the encouraging data, challenges remain. The technique requires extensive training in both endovascular and open neurosurgical skills, posing a steep learning curve. Additionally, institutional access to hybrid operating theaters is not universal, potentially limiting widespread implementation. Careful cost-benefit analyses will be essential to justify infrastructural upgrades and to balance resource allocation against clinical advantages.
Looking forward, integration of emerging technologies—for instance, intraoperative navigation coupled with real-time perfusion assessment and advanced embolic materials—could refine and personalize hybrid procedures further. Exploration into adjunct pharmacological agents to modulate angiogenesis or tumor microenvironment may also synergize with hybrid surgery, improving resection completeness and reducing recurrence. Collaborations across neurosurgical, interventional radiology, and bioengineering disciplines will be integral to such innovation pipelines.
In summary, the Beijing Tiantan Hospital team’s pioneering work on one-stage hybrid operations for hypervascular CNS tumors confronts one of neurosurgery’s enduring challenges with a bold and technically sophisticated solution. By uniting embolization and resection within a single operative event, this approach promises to substantially improve patient outcomes while reducing procedural complications and healthcare burdens. As further studies validate these findings, the neurosurgical community may witness a paradigm shift that renders this technique a new benchmark in the management of these formidable tumors.
Subject of Research: People
Article Title: One-stage hybrid operation for hypervascular central nervous system tumors: a single-center experience of 31 cases
News Publication Date: 31-Jul-2025
Web References: http://dx.doi.org/10.1186/s41016-025-00400-y
References: Wang et al., Chinese Neurosurgical Journal (2025), DOI: 10.1186/s41016-025-00400-y
Image Credits: Wang et al., Chinese Neurosurgical Journal (2025)
Keywords: Neuroscience, Neurological disorders, Central nervous system, Brain, Cancer, Health and medicine
