Introduction: Intraoperative bleeding is a significant risk in surgery for highly vascular spinal tumors, but preoperative embolization can safely decrease intraoperative blood loss in extrinsic spine tumors. Onyx (ev3, Irvine, CA), widely used for cerebrovascular embolization, has seen increasing use as an embolic agent for preoperative spinal tumor embolization. The Scepter catheter (MicroVention Inc, Tustin, CA, USA), a dual lumen balloon catheter, may improve tumor parenchymal penetration without the danger and limitations of significant embolic reflux. This may reduce bleeding risk during spinal surgery.
Methods: Eleven consecutive cases of preoperative Onyx embolization of extrinsic spinal tumors were identified, all of whom had subsequent spinal surgery. Demographics and clinical variables were collected. Patients were divided into Scepter (n=6) and non-Scepter (n=5) groups. Mann–Whitney U test was used to compare continuous outcome variables and Fisher’s exact test was used to compare categorical variables.
Results: Estimated blood loss (EBL) in the Scepter group was significantly lower than EBL in the non-Scepter group: 583±124 mL vs. 2400±738 mL, p=0.004. Volume of intra-operative transfusion was also significantly lower: 1.2±0.4 units vs. 5.8±1.7 units, p=0.004. There was no significant difference in the number of vessels embolized, vials of Onyx used, use of coiling adjunct, contrast load, radiation dose, or fluoroscopy time per pedicle (p>0.05).
Conclusions: The addition of the Scepter catheter to preoperative Onyx embolization reduced intraoperative bleeding by 76% and transfusion volume by 79%. This was not accompanied by any unwanted increase in vials of Onyx used, contrast load, radiation dose, or fluoroscopy time.
Patient Care: Intraoperative bleeding is a significant risk in surgery for highly vascular spinal tumors, but preoperative embolization can decrease bleeding complications. An inherent technical challenge and potential danger of using onyx is the occurrence of reflux flowing retrograde along the delivery catheter. The Scepter catheter promotes a quick “plug and push” technique that, through balloon occlusion just proximal to the catheter tip, virtually eliminates reflux, and allows for improved immediate distal penetration, which may hypothetically improve overall tumor parenchymal penetration without significant reflux. In our experience, the addition of the Scepter catheter to preoperative Onyx embolization of spinal tumors reduced intraoperative bleeding by 76% and transfusion volume by 79%.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Discuss the role of preoperative embolization of highly vascular spinal tumors.
2) Discuss ways in which a dual lumen balloon catheter might be a useful adjunct to tumor embolization