Preoperative Embolization of Hypervascular Thoracic, Lumbar, and Sacral Spinal Column Tumors: Technique and Outcomes from a Single Center

Abstract

<jats:p> The existing literature on preoperative spine tumor embolization is limited in size of patient cohorts and diversity of tumor histologies. This report presents our experience with preoperative embolization of hypervascular thoracic, lumbar, and sacral spinal column tumors in the largest series to date. </jats:p><jats:p> We conducted a retrospective review of 228 angiograms and 188 pre-operative embolizations for tumors involving thoracic, lumbar and sacral spinal column. Tumor vascularity was evaluated with conventional spinal angiography and was graded from 0 (same as normal adjacent vertebral body) to 3 (severe tumor blush with arteriovenous shunting). Embolic materials included poly vinyl alcohol (PVA) particles and detachable platinum coils and rarely, liquid embolics. The degree of embolization was graded as complete, near-complete, or partial. Anesthesia records were reviewed to document blood loss during surgery. </jats:p><jats:p> Renal cell carcinoma (44.2%), thyroid carcinoma (9.2%), and leiomyosarcoma (6.6%) were the most common tumors out of a total of 40 tumor histologies. Hemangiopericytoma had the highest mean vascularity (2.6) of all tumor types with at least five representative cases followed by renal cell carcinoma (2.0) and thyroid carcinoma (2.0). PVA particles were used in 100% of cases. Detachable platinum coils were used in 51.6% of cases. Complete, near-complete, and partial embolizations were achieved in 86.1%, 12.7%, and 1.2% of all cases, respectively. There were no new post-procedure neurologic deficits or other complications with long-term morbidity. The mean intra-operative blood loss for the hypervascular tumors treated with pre-operative embolization was 1745 cc. </jats:p><jats:p> Preoperative embolization of hypervascular thoracic, lumbar, and sacral spine tumors can be performed with high success rates and a high degree of safety at high volume centers. </jats:p>

Postoperative internal iliac artery embolisation as salvage therapy for bleeding in an HIV-positive patient with giant cell tumour of bone

“…[6] Preoperative embolisation has been well described in hypervascular bone tumours. [7] Embolisation of the internal iliac arteries may be complicated by ischaemia of the pelvic organs, as well as the spine, buttock and thigh. This may present as gluteal necrosis, paraplegia and impotence, bowel ischaemia, and bladder and perineal necrosis.…”

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

“…Many authors agree that it decreases intraoperative blood loss and makes the surgery safer [9,10]. However, embolization series of spinal tumors mainly discussed the intraoperative blood loss to evaluate the usefulness of interventional procedure rather than the perioperative complications [11][12][13].…”

Preoperative Embolization of a Giant Neurofibroma of the Chest in a Patient with Neurofibromatosis Type II: A Case Report

“…Neurofibromas develop frequently in individuals with Preoperative embolization is generally a safe procedure and reports low complication rates (10). However, serious complications can occur, including stroke, ischemic attack, and necrosis (10). Therefore, identification of dangerous anastomoses and careful manipulation of the catheter and injection of the embolic material are crucial to avoid serious complications.…”

“…It is a rare condition and its prevalence is estimated to be about 1 in 50000 (7). Neurofibromas develop frequently in individuals with Preoperative embolization is generally a safe procedure and reports low complication rates (10). However, serious complications can occur, including stroke, ischemic attack, and necrosis (10).…”