Treatment of spinal metastases from kidney cancer by presurgical embolization and resection

Sundaresan, Narayan; Choi, In Sup; Hughes, James E. O.; Sachdev, Ved P.; Berenstein, Alex

doi:10.3171/jns.1990.73.4.0548

Cited by 103 publications

(55 citation statements)

References 23 publications

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“…Complications include transient or permanent quadriplegia or quadriparesis as well as aortic dissections in up to 8.5 % of patients [19,20]. In our series, there were no local or systemic complications following embolisation.…”

Section: Discussionmentioning

confidence: 48%

“…The authors of previous reports have shown efficacy for renal and non-renal spinal metastases such as melanoma, sarcoma, thyroid, breast, prostate, hepatic carcinoma, and neuroendocrine tumours such as paragangliomas [6][7][8][9][10][11][12][13]. Nevertheless, the amount of blood loss is variable [13,[17][18][19][20]. The procedure is associated with minimal morbidity when performed by experienced interventional radiologists.…”

Section: Discussionmentioning

confidence: 99%

“…Pre-operative embolisation of such hypervascular tumours aims to reduce intra-operative blood loss and improves the surgeon's ability to decompress the spinal cord and maximize tumour resection [4][5][6][7][8][9][10][11][12]. Other potential benefits include reducing mass effect, arresting tumour growth, alleviating pain, and shortening hospital stays [3,13].…”

Section: Introductionmentioning

confidence: 99%

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Outcome of embolised vascular metastatic renal cell tumours causing spinal cord compression

et al. 2013

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Purpose To present the results of the surgical management of metastatic renal cell tumours of the spine with cord compression who underwent pre-operative embolisation. Methods We conducted a retrospective cohort study of all embolised vascular metastatic renal cell tumours of the spine that underwent urgent surgical intervention over a 7-year period (2005)(2006)(2007)(2008)(2009)(2010)(2011). All medical notes, images and angiography/embolisation details were studied. We recorded the timing (immediate vs. delayed) and grade of embolisation and compared this to the estimated blood loss (EBL); extent of metastatic spinal cord compression (using the Tomita score and Bilsky scores) was also compared to EBL. Finally, neurological (Frankel grade), surgical outcome and complications were reviewed in all patients. Results During the study period, we operated on 25 emergency patients with metastatic renal cell carcinoma causing spinal cord compression who had received preoperative embolisation (mean age 59.6 (24-78) years; 8 females, 17 males). All but one of our patients had hypervascularisation/arterio-venous fistulae on angiography. We were able to achieve greater than 90 % embolisation in the majority (17/25, 68 %) The estimated blood loss was 1,696 (400-5,000) ml; mean operating time was 276 (90-690) min and an average of 2.3 (0-7) units of whole blood was transfused. Nine patients had a posterior only decompression/stabilisation, nine patients had a posterior decompression ± cement augmentation, six had combined anterior/posterior procedures and one had anterior corpectomy/reconstruction alone. There was no statistical difference in the EBL between immediate versus delayed surgery after embolisation or the grade of embolisation. Immediate surgery after embolisation and interestingly less complete embolisation showed a trend towards less EBL. The extent of the tumour as graded by the Bilsky score correlated with increased EBL (p = 0.042). No complications occurred during the embolisation procedure. The surgical complication rate was 32 % (8/25) including two major complications (septicaemia (1) and metal work failure (2)) and five minor complications. Postoperatively, 52 % (13/25) had no change in neurological status, 36 % (9/25) improved by at least one Frankel grade and 12 % (3/25) had neurological deterioration by one Frankel grade. The average survival following surgery was 14.1 (0.5-72) months. Conclusion Blood loss (mean 1,696 ml) and complications (32 %) remain a concern in the operative treatment of vascular metastatic spinal cord compression. Most patients remained the same neurologically or improved by at least 1 grade (22/25, 88 %). Paradoxically, greater embolisation showed a trend to more blood loss which could be due to more extensive surgery in this group, a rebound 'reperfusion' phenomena or even the presence of arterio-venous fistulae. Interestingly, we also found that the extent of the tumour, as graded by the Bilsky score, correlated with increased blood loss suggesting that more extensive...

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcome of embolised vascular metastatic renal cell tumours causing spinal cord compression

et al. 2013

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“…aspects of vertebral tumor embolization [1,7] and showed the efficacy of preoperative embolization on perioperative blood loss [3,4,10].…”

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confidence: 99%

Preoperative transarterial embolization of vertebral metastases

et al. 2004

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IntroductionSpinal neoplastic lesions of metastatic origin severely affect patient quality of life. Metastasizing tumors show spinal manifestation in 30-70% of cases [2]. Most common primary tumors of vertebral metastases are localized in the breast, lung, prostate and kidney. Surgical intervention with corporectomy, body replacement and stabilization, although controversial, is still the best treatment option for spinal instability, neurological complications and severe pain that cannot be managed conservatively or by local radiation [8,9]. However these extensive surgical procedures are often complicated by massive intraoperative blood loss. Compared with normal vertebrae, tumorous vertebrae show extensive vascularization. The most highly vascularized vertebrae are those with metastases originating from renal cell and thyroid carcinoma [7]. Life-threatening blood losses have been described in cases without preoperative embolization [3,6] Abstract The aim of this study was to evaluate the impact of preoperative devascularization of spinal metastases in relation to the preembolization tumor vascularization degree and in relation to the intraoperative blood loss. Twenty-four patients underwent preoperative transarterial embolization of hypervascular spinal metastases. Each tumor was assigned a vascularization grade (I-III) according to tumor blush after contrast agent injection in the main feeding artery. Embolization was performed with polyvinyl alcohol particles in all patients. Surgical reports were reviewed in terms of estimated blood loss. A mild hypervascularization was found in three patients (group I), medium in six patients (group II) and extensive in 15 patients (group III). In 22 out of 24 patients embolization could be performed with a complete devascularization. In two patients, only partial embolization could be performed, due to the main feeding artery arising from the artery of Adamkiewicz. In patients with complete devascularization the mean intraoperative blood loss was 1,900 ml, whereas in the two patients who were not embolized it was 5,500 ml. Intraoperative blood loss was not correlated to the vascularization grade. Angiography and embolization could be performed in all patients without causing permanent neurologic deficit, skin or muscle necrosis. The surgeons concluded that radical tumor resection after embolization was facilitated. Intraoperative blood loss is not correlated with the pre-interventional vascularization degree, if complete devascularization can be achieved with embolization. Preoperative embolization of vertebral hypervascular tumors is safe, effective and facilitates tumor resection.

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“…In addition, some studies have shown that embolisation may cause tumour growth arrest and subsequently pain alleviation and shorter hospital stay [58][59][60]. The timing of the preoperative embolisation is also important.…”

Section: Treatmentmentioning

confidence: 99%

Management of metastatic sacral tumours

et al. 2012

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Purpose Metastatic involvement of the sacrum is rare and there is a paucity of studies which deal with the management of these tumours since most papers refer to primary sacral tumours. This study aims to review the available literature in the management of sacral metastatic tumours as reflected in the current literature. Methods A systematic review of the English language literature was undertaken for relevant articles published over the last 11 years (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). The PubMed electronic database and reference lists of key articles were searched to identify relevant studies using the terms ''sacral metastases'' and ''metastatic sacral tumours''. Studies involving primary sacral tumours only were excluded. For the assessment of the level of evidence quality, the CEBM (Oxford Centre of Evidence Based Medicine) grading system was utilised. Results The initial search revealed 479 articles. After screening, 16 articles identified meeting our inclusion criteria [1 prospective cohort study on radiosurgery (level II); 2 case series (level III); 4 retrospective case series (level IV) and 9 case reports (level IV)]. Conclusion The mainstay of management for sacral metastatic tumours is palliation. Preoperative angioembolisation is shown to be of value in cases of highly vascularised tumours. Radiotherapy is used as the primary treatment in cases of inoperable tumours without spinal instability where pain relief and neurological improvement are attainable. Minimal invasive procedures such as sacroplasties were shown to offer immediate pain relief and improvement with ambulation, whereas more aggressive surgery, involving decompression and sacral reconstruction, is utilised mainly for the treatment of local advanced tumours which compromise the stability of the spine or threaten neurological status. Adjuvant cryosurgery and radiosurgery have demonstrated promising results (if no neurological compromise or instability) with local disease control.

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Treatment of spinal metastases from kidney cancer by presurgical embolization and resection

Cited by 103 publications

References 23 publications

Outcome of embolised vascular metastatic renal cell tumours causing spinal cord compression

Outcome of embolised vascular metastatic renal cell tumours causing spinal cord compression

Preoperative transarterial embolization of vertebral metastases

Management of metastatic sacral tumours

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