Electrophysiological monitoring during preoperative angiography to guide decisions regarding permanent occlusion of major radicular arteries in patients undergoing total en bloc spondylectomy

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Preoperative embolization is performed before spine tumor surgery when significant intraoperative hemorrhage is anticipated. Occlusion of radicular and segmental arteries may result in spinal ischemia. The goal of this study was to check whether neurophysiological monitoring during preoperative angiography in patients scheduled for total en bloc spondylectomy (TES) of spine tumors improves the safety of vessel occlusion.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>This was a case series study of patients who underwent tumor embolization under somatosensory evoked potential (SSEP) and motor evoked potential (MEP) monitoring in preparation for TES in treating spine tumors. The angiography findings, the embolized vessels, and the results are presented.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Five patients whose ages ranged from 33 to 75 years and who had thoracic spine tumors are reported. Four patients suffered from primary tumor and 1 patient had a metastatic tumor. Radicular arteries at the tumor level, 1 level above, and 1 level below were permanently occluded when SSEPs and MEPs were preserved during temporary occlusion. No complications were encountered during or after the angiography procedure and embolization.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Temporary occlusion with electrophysiological monitoring during preoperative angiography may improve the safety of permanent radicular artery occlusion, including the artery of Adamkiewicz in patients undergoing TES for the treatment of spine tumors.</jats:p></jats:sec>

The Safety Profile of Intentional or Iatrogenic Sacrifice of the Artery of Adamkiewciz and Its Vicinity’s Spinal Segmental Arteries: A Systematic Review

“…As such, a total of 10 articles are included in this review ( Table 1). The included studies were all retrospective case series, with 7 published in the spine literature, [14][15][16][17][18][19][20] and 3 in the vascular literature. 13,21,22 Included studies had a range of 5 to 346 patients (median, N ¼ 31.5).…”

“…Three studies 13,14,20 had information on the effects of AoA occlusion with a crude postoperative motor neurological deficit rate of 4.0% (2 of 50 total patients). The number of bilateral SSAs occluded (including the AoA) in these 3 articles ranged from 1 to 12 pairs.…”

“…Eight articles met the inclusion criteria, 6 articles [15][16][17]19,20,23 from the spinal surgical literature, and 2 articles 21,22 from the vascular surgical literature. Only 2 studies 19,21 had information on the exact vertebral levels where the SSAs were occluded.…”

“…Salame et al 20 published a small case series investigating the safety of endovascular embolization for vertebral tumors using endovascular coils or onyx. Intraprocedural neurophysiological monitoring was used as an adjunct.…”

A Radiologists' Guide to En Bloc Resection of Primary Tumors in the Spine: What Does the Surgeon Want to Know?

“…An initial small study has assessed the role of electrophysiological monitoring during preoperative embolization of major radicular arteries in guiding decisions regarding permanent occlusion of these vessels, which may prove useful in particularly challenging cases. 40 …”