Schirmer Clemens M, Malek Adel M, Kwan Eddie S, Hoit Daniel A, Weller Simcha J
Cerebrovascular and Endovascular Division, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
Neurosurgery. 2006 Aug;59(2):E431-2; author reply E431-2. doi: 10.1227/01.NEU.0000223503.92392.CE.
Intraoperative blood loss constitutes a major cause of perioperative morbidity in surgical decompression and reconstruction of highly vascular spinal metastatic tumors. We propose a technique for embolization of highly vascular vertebral metastases using percutaneous direct injection using n-butyl cyanoacrylate (NBCA) instead of polymethylmethacrylate to complement preoperative transarterial embolization and to minimize operative blood loss.
Five patients with renal cell carcinoma metastases to the spine (one cervical, one thoracic, and three lumbar) underwent embolization by percutaneous direct injection of the affected vertebrae with a mixture of NBCA and iodized oil to supplement transarterial embolization with polyvinyl alcohol particles and fibered platinum coils. This was achieved via a transpedicular approach in four cases and by direct vertebral body puncture in one case.
The percutaneous NBCA direct injection procedure was technically successful in all cases and was not associated with neurological or medical complications. All patients underwent subsequent vertebrectomy and spinal instrumentation. Surgical resection was performed with lower than expected blood loss and with a subjective improvement in tumor tissue handling and dissection.
The extent of tumor devascularization can be improved by supplementing transarterial embolization with NBCA direct injection to decrease operative blood loss and increase the safety of surgical resection and stabilization of highly vascular spinal metastases.
术中失血是高血运脊柱转移瘤手术减压和重建围手术期发病的主要原因。我们提出一种使用正丁基氰基丙烯酸酯（NBCA）经皮直接注射栓塞高血运椎体转移瘤的技术，以替代聚甲基丙烯酸甲酯，作为术前经动脉栓塞的补充，减少术中失血。
5例肾细胞癌脊柱转移患者（1例颈椎、1例胸椎和3例腰椎）接受了经皮直接向患椎注射NBCA与碘化油混合物的栓塞治疗，以补充经动脉注射聚乙烯醇颗粒和纤维铂金线圈的栓塞治疗。4例通过经椎弓根途径完成，1例通过直接椎体穿刺完成。
经皮NBCA直接注射操作在所有病例中技术上均获成功，且未出现神经或内科并发症。所有患者随后均接受了椎体切除术和脊柱内固定术。手术切除时失血低于预期，肿瘤组织处理和分离的主观效果有所改善。
通过经动脉栓塞联合NBCA直接注射可提高肿瘤去血管化程度，减少术中失血，提高高血运脊柱转移瘤手术切除及稳定操作的安全性。
