Shi H B, Suh D C, Lee H K, Lim S M, Kim D H, Choi C G, Lee C S, Rhim S C
Department of Radiology, First Affiliated Hospital of Nanjing Medical University, China.
AJNR Am J Neuroradiol. 1999 Nov-Dec;20(10):2009-15.
The techniques of preoperative embolization of hypervascular spinal tumors, which has been known to be helpful for completing tumor resection, have not been described in detail. The purpose of this study was to analyze the technique and to evaluate the safety and value of preoperative transarterial embolization of hypervascular spinal tumors.
Eighteen patients with hypervascular spinal tumors underwent transarterial embolization before surgery. The lesions were located between the upper cervical and lower lumbar spine: C1-T1 (n = 6), T5-L3 (n = 11), and L5 (n = 1); they arose intradurally in six patients and extradurally in 12. Thirty-one arteries were embolized with polyvinyl alcohol (PVA) particles (150-500 microm), and, in 18 of these, pieces of gelatin sponge were added for proximal pedicular embolization. The criteria for judging the effectiveness of embolization were completeness of tumor removal and estimated blood loss during surgery.
Tumor embolization was total in eight patients, nearly total in seven, subtotal in one, and partial in two. There were no symptomatic complications associated with embolization. Tumors were totally removed in 17 patients and nearly totally removed in one. The average estimated blood loss during surgery was 1100 mL (range, 200-6000 mL) for all 18 patients, and 1540 mL in patients with extradural tumors.
Preoperative embolization of hypervascular spinal tumors is safe and effective. It can make complete resection of a tumor possible and can make an unresectable tumor resectable. Superselection or flow control is necessary to achieve effective devascularization and to avoid complications.
高血运脊柱肿瘤的术前栓塞技术有助于肿瘤切除，但此前尚未有详细描述。本研究旨在分析该技术，并评估高血运脊柱肿瘤术前经动脉栓塞的安全性及价值。
18例高血运脊柱肿瘤患者在手术前行经动脉栓塞。病变位于上颈椎至下腰椎：C1-T1（6例），T5-L3（11例），L5（1例）；其中6例病变位于硬膜内，12例位于硬膜外。31支动脉用聚乙烯醇（PVA）颗粒（150 - 500微米）栓塞，其中18支动脉加用明胶海绵碎片进行近端蒂部栓塞。栓塞效果的判断标准为肿瘤切除的完整性及术中估计失血量。
8例患者肿瘤栓塞完全，7例近完全，1例次全，2例部分栓塞。栓塞未出现有症状的并发症。17例患者肿瘤完全切除，1例近完全切除。18例患者术中平均估计失血量为1100毫升（范围200 - 6000毫升），硬膜外肿瘤患者术中平均估计失血量为1540毫升。
高血运脊柱肿瘤术前栓塞安全有效。它可使肿瘤完整切除成为可能，也可使不可切除的肿瘤变为可切除。超选择或血流控制对于实现有效的血管减容及避免并发症是必要的。
