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.
Similar content being viewed by others
References
Berkfeld J, Scale D, Kirchner J, Heinrich T, Kollath J (1999) Hypervascular spinal tumors: Influence of the embolization technique on perioperative hemorrhage. AJNR AM J Neuroradiol 20:757–763
Boland PJ, Lene JM, Sundersen N (1982) Metastatic disease of the spine. Clin Orthop 1169:95–102
Gellad FE, Sadato N, Numaguchi Y, Levine AM (1990) Vascular metastatic lesions of the spine: preoperative embolization. Radiology 176:683–686
Görich J, Solymosi L, Hasan I, Sittek H, Majdali R, Reiser M (1995) Embolisation von Knochenmetastasen. Radiologe 35:55–59
Manke C, Bretschneider T, Lenhart M, Strotzer M, Neumann C, Gmeinwieser J, Feuerbach S (2001) Spinal metastases from renal cell carcinoma: effect of preoperative particle embolization on intraoperative blood loss. AJNR AM J Neuroradiol 22:997–1,003
Olerud C, Jonsson H Jr, Lofberg AM, Lorelius LE, Sjostrom L (1993) Embolization of spinal metastases reduces perioperative blood loss. 21 patients operated on for renal cell carcinoma. Acta Orthop Scand 64:9–12
Shi HB, Suh DC, Lee HK, Lim SM, Kim DH, Choi CG, Lee CS, Rhim SC (1999) Preoperative transarterial embolization of spinal tumors: embolization techniques and results. AJNR AM J Neuroradiol 20:2,009–2,015
Siegal T, Tiqva P, Siegal T (1985) Vertebral body resection for epidural compression by malignant tumors, results of 47 consecutive operative procedures. J Bone Joint Surg 67:375–382
Sundaresan N, Gailicich JH, Lane JM, Bains MS, McCormack P (1985) Treatment of epidural cord compression by vertebral body resection and stabilization. J Neurosurg 63:676–684
Sundaresan N, Choi IS, Hughes JEO, Sachdev VP, Berenstein A (1990) Treatment of spinal metastases from kidney cancer by presurgical embolization and resection. J Neurosurg 73:548–554
Tadavarthy SM, Möller JH (1974) Polyvinyl alcohol (Ivalon): a new embolic material. AJR AM J Roentgenol 125:609–616
Vetter SC, Strecker EP, Ackermann LW, Harms J (1997) Preoperative embolization of cervical spine tumors. Cardiovasc Intervent Radiol 20:343–347
Acknowledgements
Special thanks go to Mrs. Fügliskater from Johnson & Johnson, Division Cordis, Switzerland for supplying the illustration of the Berner Spinalkatheter I-III
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Guzman, R., Dubach-Schwizer, S., Heini, P. et al. Preoperative transarterial embolization of vertebral metastases. Eur Spine J 14, 263–268 (2005). https://doi.org/10.1007/s00586-004-0757-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-004-0757-6