Surgical treatment of giant cell tumors of the sacrum and spine combined with pre-operative transarterial embolization

Abstract

Abstract. The pre-operative embolization of hypervascular spinal tumors is often performed to decrease intraoperative blood loss and facilitate tumor resection; however, few studies have been published on its effectiveness in giant cell tumors (GCT) of the sacrum and spine. The purpose of the present study was to investigate the value of surgical excision with pre-operative transarterial embolization for GCTs of the sacrum and spine, and to evaluate the follow-up outcomes. A retrospective study was performed on 28 patients with GCTs of the sacrum and spine, who underwent surgical treatment combined with pre-operative transarterial embolization between June 1995 and August 2011. The intraoperative blood loss, transfusion, duration of surgery, treatment, local recurrence, complications, follow-up status and functional outcome were reviewed. The average follow-up period was 86.3 months (range, 12-193 months). All the patients were treated with intralesional resection without any intraoperative shock or fatalities. The average intraoperative level of blood loss was 1,528.6 ml (range, 400-5,800 ml), the average transfusion volume was 1,514.3 ml (range, 400-6,000 ml) and the average duration of surgery was 225.4 min (range, 120-470 min). In total, eight (28.6%) patients developed recurrence and two patients succumbed. A total of eight (28.6%) patients experienced complications and 24 (85.7%) retained normal neurological function. Pre-operative embolization significantly decreases intraoperative blood loss and facilitates the maximal removal of the tumor. Pre-operative embolization followed by intralesional resection is able to achieve satisfactory local control and clinical outcomes. It is an effective technique for excising GCTs of the sacrum and spine.

Recurrence of Giant Cell Tumor of the Spine after Resection: A Report of 10 Cases

“…Serial SAE as a stand‐alone treatment for SGCT is not a highly effective approach; it is usually used in inoperable SGCT24. Its main role is to reduce intraoperative blood loss, especially for intralesional curettage25. In our practice, we performed SAE preoperatively in a recurrent SGCT of the 12th thoracic vertebral (case 5) to reduce the blood loss during the operation.…”

Reconstructive surgery using dual U-shaped rod instrumentation after posterior en bloc sacral hemiresection for metastatic tumor: case report

“…This technique is also used as a primary or adjuvant therapy to reduce tumor size and intraoperative blood loss in patients with malignant or metastatic lesions. 18 In the present case, because of an uncertain pathological diagnosis and the vascularity of the lesion, we attempted embolization to reduce intraoperative blood loss and improve the surgical outcome.…”

Paediatric musculoskeletal interventional radiology

“…22 Pre-operative embolization of hypervascular musculoskeletal tumours is a safe and effective technique able to reduce intraoperative blood loss. [18][19][20][21][22] MUSCULOSKELETAL BENIGN TUMOURS Image-guided bone biopsies play an important role in the diagnosis of benign bone lesions using FNA and core cytology bone biopsy (CCBB). CT is generally the imaging technique chosen to guide the biopsy procedure as it offers great precision in terms of the access route and in relation to the intralesional sampling.…”

“…Particular attention should be paid to the visualization of spinal arteriesartery of Adamkiewicz-in case of the spine neoplasms. 18,21 Commonly used embolic agents are the absorbable gelatin sponge (AGS) and polyvinyl alcohol (PVA) particles, coils and glue. AGS and PVA are usually preferred for distal embolization.…”

“…Tumour location in the pelvis or spine often requires pre-surgical selective embolization as a useful adjuvant treatment to minimize intraoperative blood loss and improve the tumour resectability. [18][19][20][21][22] Pre-operative angiography must identify tumour-feeding vessels. Particular attention should be paid to the visualization of spinal arteriesartery of Adamkiewicz-in case of the spine neoplasms.…”