Preoperative embolization of feeding arteries in glioblastoma: Technical strategies and clinical utility

BACKGROUND: Maximal safe resection-balancing aggressive tumor removal with neurological preservation-is essential in glioblastoma surgery. Cerebral angiography enables identification of the dominant hemisphere, feeding arteries, and vessels crossing eloquent areas, thereby aiding intraoperative planning. Preoperative embolization of glioblastoma feeders may shorten operative time and reduce intraoperative bleeding, similar to its established role in extra-axial tumors. We hypothesized that embolization could serve not as a routine adjunct but as a targeted strategy for selected glioblastomas with deep-seated or hypervascular feeders that increase surgical complexity. METHODS: Between December 2023 and July 2025, 15 consecutive patients with glioblastoma underwent preoperative embolization under local anesthesia using a 3-Fr distal radial approach. Coils and n-butyl-2-cyanoacrylate (NBCA) were used as embolic materials. Cerebral angiography and the Wada test (intracarotid amobarbital procedure) were performed to evaluate vascular anatomy and hemispheric dominance. RESULTS: The embolization procedure required a mean of 1 h 26 min. Microscope-assisted tumor resection averaged 3 h 1 min, with a mean blood loss of 389 mL. No neurological or ischemic complications occurred, and postoperative MRI confirmed the absence of new ischemic changes. CONCLUSIONS: Preoperative embolization of glioblastoma-feeding arteries may provide a clear and bloodless surgical field, enhances spatial orientation through radiopaque contrast marking, and facilitates precise intraoperative localization. By reducing intraoperative bleeding, surgical complexity, and anesthesia time, this selective technique may decrease the overall invasiveness of glioblastoma surgery. When performed via a minimally invasive distal radial approach, preoperative embolization is a safe, feasible, and practical adjunct that enhances the precision and efficiency of glioblastoma resection.