Hypervascular tumors of the central nervous system (CNS), including meningiomas, hemangioblastomas, and paragangliomas, remain among the most challenging conditions for neurosurgeons to treat. Their dense vascular networks obscure tumor boundaries and elevate the risk of bleeding and neurological damage. Conventional treatment has typically relied on a two-stage process—embolization followed days later by microsurgical resection—which can introduce risks such as swelling, hemorrhage, and delays between procedures.
In a decade-long clinical study, neurosurgeons at Beijing Tiantan Hospital demonstrated that performing both embolization and tumor resection in a single session significantly improves patient safety and outcomes. This approach, termed a one-stage hybrid operation, was evaluated in 31 patients between 2014 and 2024 and published on July 31, 2025, in the Chinese Neurosurgical Journal .
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. Average intraoperative blood loss was more than one liter lower than typically seen in staged procedures. Importantly, no embolization-related complications occurred. At discharge, 87 percent of patients demonstrated stable or improved neurological function, and at 12 months, two-thirds of patients were symptom-free.
The technique focuses on selective embolization of deep or surgically inaccessible arterial feeders while leaving superficial vessels for surgical management. Materials such as ethylene vinyl alcohol copolymer (EVOH), detachable coils, and silk suture fragments were employed for targeted occlusion, with balloon catheters occasionally used to provide temporary vascular control during craniotomy. Rather than aiming for complete blockage, the embolization strategy reduced intraoperative bleeding risk while permitting immediate tumor removal under the same anesthesia.
All procedures were carried out in a hybrid operating room, integrating advanced facilities for both endovascular and open neurosurgical procedures. This setting allowed the surgical team to seamlessly transition between embolization and resection, thereby reducing operative time and patient stress.
"Our experience shows that the one-stage hybrid operation is both safe and effective for managing hypervascular CNS tumors," said Professor Yi Lu, the study's lead investigator. Co-author Professor Li added that while these results are promising, larger prospective studies are needed to confirm its advantages over conventional staged treatments.
If validated, the one-stage hybrid approach could set a new standard for managing hypervascular CNS tumors, providing a safer and more efficient option for patients facing these high-risk conditions.
