Preoperative embolization of hypervascular spinal tumors: current practice and center experience

Pikis, Stylianos; Itshayek, Eyal; Barzilay, Yair; Hasharoni, Amir; Kaplan, Leon; Gomori, Moshe; Cohen, José E.

doi:10.1179/1743132814y.0000000361

Cited by 35 publications

(28 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Moreover, highly vascularized tumors including renal and thyroid carcinoma are associated with a high risk of massive blood loss. In this regard, transarterial embolization has been reported to decrease perioperative bleeding in hypervascular tumors [5,8-10,12,15,16,21]. However, consensus regarding embolization in non-hypervascular spinal metastasis has yet to be achieved [3,8,16,17].…”

Section: Introductionmentioning

confidence: 99%

Clinical Significance of Preoperative Embolization for Non-Hypervascular Metastatic Spine Tumors

Yoo

Kim

Park

et al. 2019

J Korean Neurosurg Soc

View full text Add to dashboard Cite

ObjectiveThe efficacy of preoperative embolization for hypervascular metastatic spine disease (MSD) such as renal cell and thyroid cancers has been reported. However, the debate on the efficacy of preoperative embolization for non-hypervascular MSD still remains unsettled. The purpose of this study is to determine whether preoperative embolization for non-hypervascular MSD decreases perioperative blood loss. MethodsA total of 79 patients (36 cases of preoperative embolization and 43 cases of non-embolization) who underwent surgery for metastatic spine lesions were included. Representative hypervascular tumors such as renal cell and thyroid cancers were excluded. Intraoperative and perioperative estimated blood losses (EBL), total number of transfusion and calibrated EBL were recorded in the embolization and non-embolization groups. The differences in EBL were also compared along with the type of surgery. In addition, the incidence of Adamkiewicz artery and complications of embolization were assessed. ResultsThe average age of 50 males and 29 females was 57.6±13.5 years. Lung (30), hepatocellular (14), gastrointestinal (nine) and others (26) were the primary cancers. The demographic data was not significantly different between the embolization and the non-embolization groups. There were no significant differences in intraoperative EBL, perioperative EBL, total transfusion and calibrated EBL between two groups. However, intraoperative EBL and total transfusion in patients with preoperative embolization were significantly lower than in non-embolization in the corpectomy group (1645.5 vs. 892.6 mL, p=0.017 for intraoperative EBL and 6.1 vs. 3.9, p=0.018 for number of transfusion). In addition, the presence of Adamkiewicz artery at the index level was noted in two patients. Disruption of this major feeder artery resulted in significant changes in intraoperative neuromonitoring. ConclusionPreoperative embolization for non-hypervascular MSD did not reduce perioperative blood loss. However, the embolization significantly reduced intraoperative bleeding and total transfusion in corpectomy group. Moreover, the procedure provided insights into the anatomy of tumor and spinal cord vasculature.

show abstract

Section: Introductionmentioning

confidence: 99%

Clinical Significance of Preoperative Embolization for Non-Hypervascular Metastatic Spine Tumors

Yoo

Kim

Park

et al. 2019

J Korean Neurosurg Soc

View full text Add to dashboard Cite

show abstract

“…Many authors demonstrated that preoperative embolization for spinal tumor is a safe procedure [9,10,12,20] and no complications were observed in their series [9,10,12,16,20]. However, it does carry certain risks for complication (i.e., cerebral infarction, cord ischemia, aortic dissection, and muscle necrosis) and the published rates of complication vary from 1 to 8.5 % [11,[21][22][23].…”

Section: Discussionmentioning

confidence: 92%

Risk factors for major complications in surgery for hypervascular spinal tumors: an analysis of 120 cases with adjuvant preoperative embolization

Tang

et al. 2015

Eur Spine J

View full text Add to dashboard Cite

show abstract

“…Preoperative tumor embolization is a standard for surgery of hypervascular spinal tumors. 19 – 23 Nonetheless, not all sources of intraoperative bleeding can be controlled by means of arterial embolization. Difficulties in accessing the operation field and networks of venous structures and technical problems provide a small residual risk of massive hemorrhage even if the tumor itself is completely excluded from the arterial circulation.…”

Section: Discussionmentioning

confidence: 99%

Preoperative embolization versus local hemostatic agents in surgery of hypervascular spinal tumors

et al. 2014

View full text Add to dashboard Cite

BackgroundCurrently, there is no consensus about how to reduce the intraoperative risk of hemorrhage in spinal decompression surgery of hypervascular spinal tumors, such as aggressive hemangioma, multiple myeloma, plasmacytoma, metastasis of renal cell carcinoma.MethodsA retrospective study of 110 patients, operated in our institute was held in the period between 2003 and 2013. There were 69 male and 41 female patients with extradural hypervascular spinal tumor. The study included 61 patients with metastasis of renal cell carcinoma, 27 with multiple myeloma, 15 with plasmacytoma and 7 with aggressive hemangioma.The first group included 57 patients who underwent preoperative tumor embolization. The second group consisted of 53 patients, which were treated surgically using intraoperative local hemostatic agents. We performed 2 types of treatment options: palliative decompression and total spondylectomy. The first group was divided into two subgroups: 30 patients with palliative decompression (1PD) and 27 with total spondylectomy (1TS). In the second group there were: 28 patients with palliative decompression (2PD) and 25 with total spondylectomy (2TS). The parameters under evaluation were the blood loss volume, drainage loss, operation time, hemoglobin level, possible complications and time of hospital stay.ResultsThe average intraoperative blood loss for all embolized patients was slightly less than in subgroups with local hemostatic agents. No significant difference in blood loss volume was found between groups 1PD and 2PD (p > 0.05). In groups 1TS and 2TS, we did get significant difference (p < 0.05).Statistically significant difference in the average drainage loss was found between two methods of hemostasis in both subgroups (p < 0.05). The operation time was not significantly different between groups. Postoperative hemoglobin level reduce is almost equal in both groups of patients. Postoperative complications were also nearly equal in the groups. The average hospital stay was significantly less (p < 0.05) in groups with 2PD and 2TS.ConclusionsThe research proves that for patients with hypervascular spinal tumors, who underwent palliative decompression, there is no significant difference between two methods of reducing blood loss. Therefore, we do not see reasons to use expensive and risky procedure of embolization for such patients. While for patients with total spondylectomy preoperative embolization is efficient to reduce intraoperative bleeding.

show abstract

Preoperative embolization of hypervascular spinal tumors: current practice and center experience

Cited by 35 publications

References 37 publications

Clinical Significance of Preoperative Embolization for Non-Hypervascular Metastatic Spine Tumors

Clinical Significance of Preoperative Embolization for Non-Hypervascular Metastatic Spine Tumors

Risk factors for major complications in surgery for hypervascular spinal tumors: an analysis of 120 cases with adjuvant preoperative embolization

Preoperative embolization versus local hemostatic agents in surgery of hypervascular spinal tumors

Contact Info

Product

Resources

About