Vascular metastatic lesions of the spine: preoperative embolization.

Gellad, Fouad; Sadato, Norihiro; Numaguchi, Yuji; Levine, Alan M.

doi:10.1148/radiology.176.3.2389026

Cited by 137 publications

(76 citation statements)

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“…No agreement exists on the effect of degree of devascularization on estimated blood loss. Some authors suggest that tumor devascularization reduces estimated blood loss [2,4,6,16]; however, some have found no correlation between tumor devascularization and estimated blood loss [7]. In our study, we found no correlation between degree of devascularization and estimated blood loss.…”

Section: Discussioncontrasting

confidence: 93%

Embolization of Hypervascular Bone Metastases Reduces Intraoperative Blood Loss: A Case-control Study

Pazionis

Papanastassiou

Maybody

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Small case series suggest that preoperative transcatheter arterial embolization minimizes bleeding and facilitates surgery for hypervascular metastatic bone tumors. However, control groups would make our confidence in clinical recommendations stronger, but small patient numbers make prospective trials difficult to conduct on this topic. Questions/purposes In this case-control study, we asked whether (1) patients who undergo embolization have less estimated blood loss and/or shorter operative time than patients who do not have embolization; (2) larger tumor size, greater initial tumor vascularity, and longer interval from embolization to surgery are associated with greater estimated blood loss and packed red blood cell transfusion volume; and (3) embolization does not affect renal function in patients with normal preoperative renal function. Methods We retrospectively reviewed records of patients with hypervascular bone metastases treated at our institution between 1998 and 2008. Twenty-seven patients with renal cell carcinoma and 12 with thyroid carcinoma who underwent embolization before 41 surgical procedures were matched to 41 patients who did not have embolization with respect to age, diagnosis, tumor size and potential vascularity, and procedure type; matching was performed without knowledge of outcomes. In univariate and multivariate analyses, age, tumor size, use of embolization, surgery type and risk, embolization-to-surgery interval, and degree of devascularization were evaluated for correlations with estimated blood loss, packed red blood cell transfusion volume, operative time, and postembolization renal function. Results Overall, patients who had embolization had less mean estimated blood loss (0.90 versus 1.77 L; p = 0.002), packed red blood cell transfusion volume (2.15 versus 3.56 U; p = 0.020), and operative time

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Section: Discussioncontrasting

confidence: 93%

Embolization of Hypervascular Bone Metastases Reduces Intraoperative Blood Loss: A Case-control Study

Pazionis

Papanastassiou

Maybody

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…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.…”

Section: Introductionmentioning

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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“…Generally, it is recommended that embolisation should be performed as close as possible to the time of surgery. Typically, best results are achieved when surgery is performed within 24-48 h after embolisation [58,[61][62][63].…”

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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Vascular metastatic lesions of the spine: preoperative embolization.

Cited by 137 publications

References 0 publications

Embolization of Hypervascular Bone Metastases Reduces Intraoperative Blood Loss: A Case-control Study

Embolization of Hypervascular Bone Metastases Reduces Intraoperative Blood Loss: A Case-control Study

Preoperative transarterial embolization of vertebral metastases

Management of metastatic sacral tumours

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