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  • Preoperative Spinal Tumor Embolization: An Institutional Experience

    Final Number:

    George M. Ghobrial MD; Nohra Chalouhi MD; James S. Harrop MD, FACS; Richard T. Dalyai MD; Stavropoula I. Tjoumakaris MD; L. Fernando Gonzalez MD; Aaron S. Dumont MD; David M. Hasan MD; Robert H. Rosenwasser MD, FACS, FAHA; Pascal Jabbour MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Preoperative embolization has the potential to decrease intraoperative blood loss and facilitate spinal cord decompression and tumor resection .

    Methods: A retrospective case review was conducted on patients undergoing preoperative transarterial embolization of a spinal tumor between 1995 and 2012 at our institution.

    Results: 30 patients met the inclusion criteria, with a mean age of 60.6 years. Twenty-eight patients had metastatic tumors and 2 patients had hemangiomas. In 14 (50%) patients the metastases were from renal cell carcinomas. 54 vessels were embolized using PVA, NBCA, Onyx, coils, or embospheres. Sixteen patients were treated with Onyx, 6 patients with PVA, 3 patients with embospheres, 2 patients with NBCA, and 3 patients with a combination of embolic agents. The average decrease in tumor blush was 97.8% with Onyx versus 92.6% with the rest of the embolic agents (p=0.08). The estimated blood loss was 1616 ml (range 350-5000 ml). Blood loss was 1385 cc on average with Onyx versus 1763 with the rest of the embolic agents (p=0.5). The mean length of stay was 16 days. The mortality rate was zero. Pre- and post-operative modified Rankin Score (mRS) did not differ significantly in the series (3.12 vs. 3.10, respectively, p=0.9).

    Conclusions: In our experience, the use of transarterial tumor embolization as an adjunct for spinal surgery is safe and effective.

    Patient Care: To promote awareness of the safety and efficacy of preoperative embolization of spinal tumors in hopes to lower the morbidity of spinal surgery, particularly intraoperative blood loss.

    Learning Objectives: At the conclusion of this presentation, the reader will be familiar with: the use of endovascular embolization of hypervascular extradural spinal tumors with several embolic agents.

    References: Ashour R, Aziz-Sultan MA, Soltanolkotabi M, Schoeneman SE, Alden TD, Hurley MC, et al: Safety and efficacy of onyx embolization for pediatric cranial and spinal vascular lesions and tumors. Neurosurgery 71:773-784, 2012 Berkefeld J, Scale D, Kirchner J, Heinrich T, Kollath J: Hypervascular spinal tumors: influence of the embolization technique on perioperative hemorrhage. AJNR Am J Neuroradiol 20:757-763, 1999 Bilsky MH, Lis E, Raizer J, Lee H, Boland P: The diagnosis and treatment of metastatic spinal tumor. Oncologist 4:459-469, 1999

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