Preoperative Embolization of Spinal Metastatic Tumor: The Use of Selective Computed Tomography Angiography for the Detection of Radiculomedullary Arteries

Chatani, Shohei; Haimoto, Shoichi; Sato, Yozo; Hasegawa, Takaaki; Murata, Shinichi; Yamaura, Hidekazu; Inaba, Yoshitaka

doi:10.22603/ssrr.2020-0202

Cited by 4 publications

(4 citation statements)

References 32 publications

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“…Chatani et al underlined the role of selective CT angiography in the detection of radiculomedullary arteries that were not visible in DSA due to large metastatic mass with destruction and tumour blush of the vertebral body [26]. As far as transient neurological deficits are concerned, some authors attribute them to tumour swelling resulting in spinal cord compression [27]. This is believed to be relevant especially in case of highly vascular tumours with multiple and complex feeding vessel architecture that require long and extensive endovascular treatment.…”

Section: Discussionmentioning

confidence: 99%

Preoperative embolisation of renal cell carcinoma metastases to the spine – evaluation of procedural and clinical outcome

Szmygin,

Pyra

et al. 2024

Pol J Radiol

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IntroductionRenal cell carcinoma (RCC) is the fourth most common metastatic tumour of the spine. RCC metastases are highly vascular and might cause life-threatening intraoperative bleeding. That is why preoperative embolisation is performed to reduce intraoperative blood loss. The aim of this study was to evaluate the procedural and clinical outcomes of preoperative embolisation of RCC metastases to the vertebral column.Material and methodsIn this single-centre retrospective study, data of 59 consecutive patients undergoing endovascular treatment prior to surgical resection were collected and evaluated. In all cases superselective catheterisation and occlusion of feeding vessels was attempted and performed if deemed safe and possible. Completeness of embolisation, procedural details, and the complication rate were evaluated. Surgical procedures were carried out within 48 hours after embolisation. The surgical approach was dependent on the anatomical site and osseous destruction. Intraoperative blood loss was estimated.ResultsFifty-nine patients with a mean age of 63 years were included. Complete embolisation was successful in 76% (45/59) and partial in 15% (9/59). Microspheres were the most commonly used embolic material. In 5 cases (8%) safe occlusion was not possible due to the radiculomedullary artery originating from the same pedicle as the tumour. Minor complications (vomiting, increased pain) occurred in 8 patients. Paraplegia (one transient and one permanent) was noted in 2 cases. Estimated intraoperative blood loss was 830 ± 410 ml.ConclusionsThe results of our study show that preoperative embolisation is a feasible and effective method with a relatively high rate of occlusion and low complication rate.

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Section: Discussionmentioning

confidence: 99%

Preoperative embolisation of renal cell carcinoma metastases to the spine – evaluation of procedural and clinical outcome

Szmygin,

Pyra

et al. 2024

Pol J Radiol

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“…Preoperative embolization of hypervascular vertebral tumors has been described as safe and effective in previous studies, [1][2][3] potentially limiting blood loss and rendering previously unresectable tumors resectable. 4 However, spinal cord ischemia with transient or permanent paraplegia after inadvertent interruption of the AKA represents dreaded complications of surgical and interventional radiological procedures of the spine and thoracoabdominal cavity. 5,6 There is a lack of consensus and high-level evidence concerning the iatrogenic sacrifice of the AKA (and possibly various segmental spinal arteries), its potential neurological detriment, as well as preventative or restorative measures in case of spinal cord ischemia.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Coil-Embolization of a Large, Myelon-Compressing Vertebral Metastasis Involving the Artery of Adamkiewicz

Becker

Becker²,

Stuebig

et al. 2023

Journal of Clinical Interventional Radiology ISVIR

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Background Metastatic spinal cord compression causes neurologic impairment and pain, potentially improved by decompression surgery at the risk of heavy intraoperative bleeding. Preoperative embolization carries the risk of nontarget embolization, potentially causing spinal ischemia. Current evidence indicates that knowledge of artery of Adamkiewicz (AKA) location and the amount of collateralization may help estimate the risk of postinterventional spinal cord injury. Case Presentation In this case of a 73-year-old female patient with progression of a large, myelon-compressing vertebral metastasis of L1, protective, blood-flow-controlling occlusion of the proximal-most points of the AKA and segmental spinal arteries was safely performed prior to tumor embolization, surgical decompression, and tumor debulking.

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“…Preoperative embolization for spinal tumors had a risk of spinal ischemia [ 16 ]. Selective computed tomography angiography for detecting radiculomedullary arteries was an effective method to find radiculomedullary arteries and improve security [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors of total blood loss in the posterior surgery for patients with thoracolumbar metastasis

Cui

Shi

et al. 2021

BMC Musculoskelet Disord

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Background Blood loss in posterior surgery patients with thoracolumbar metastasis posed a significant challenge to surgeons. This study aimed to explore the risk factors of blood loss in posterior surgery for patients with thoracolumbar metastasis. Methods One hundred forty-two patients were retrospectively reviewed. Their baseline characteristics were recorded. The Gross equation was used to calculate blood loss on a surgical day. Multivariate linear regression was used to analyze the risk factors. Results Mean blood loss of 142 patients were 2055 ± 94 ml. Hypervascular primary tumor (kidney, thyroid and liver) (P = 0.017), wide or marginal excision (en-bloc: P = 0.001), metastasis at the lumbar spine (P = 0.033), and the presence of extraosseous tumor mass (P = 0.012) were independent risk factors of blood loss in the posterior surgery. Sub-analysis showed that wide or marginal excision (en-bloc: P < 0.001) and metastasis at lumbar spine (P = 0.007) were associated with blood loss for patients with non-hyper vascular primary tumors. Wide or marginal excision (piece-meal: P = 0.014) and the presence of an extraosseous tumor mass (P = 0.034) were associated with blood loss for patients with hypervascular primary tumors. Conclusion Hypervascular primary tumor (kidney, thyroid, and liver) was an independent risk factor of blood loss in the posterior surgery. The presence of extraosseous tumor mass and wide or marginal excision (piece-meal) were independent risk factors for patients with hypervascular primary tumors. Metastasis at the lumbar spine and wide or marginal excision (en-bloc) were independent risk factors for patients with non-hyper vascular primary tumors.

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Preoperative Embolization of Spinal Metastatic Tumor: The Use of Selective Computed Tomography Angiography for the Detection of Radiculomedullary Arteries

Abstract: This study has obtained IRB approval from our institution and the need for informed consent was waived (Aichi Cancer Center Hospital IRB, approval code; 2018-1-343). Consent for publication was obtained for every individual person's data included in the study.

Cited by 4 publications

References 32 publications

Preoperative embolisation of renal cell carcinoma metastases to the spine – evaluation of procedural and clinical outcome

Preoperative embolisation of renal cell carcinoma metastases to the spine – evaluation of procedural and clinical outcome

Preoperative Coil-Embolization of a Large, Myelon-Compressing Vertebral Metastasis Involving the Artery of Adamkiewicz

Risk factors of total blood loss in the posterior surgery for patients with thoracolumbar metastasis

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