Division of Endovascular Neurosurgery and Interventional Neuroradiology, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Spine J. 2013 Feb;13(2):141-9. doi: 10.1016/j.spinee.2012.10.031. Epub 2012 Dec 6.
Patients with spinal tumors are often referred for preoperative angiography and embolization before surgical resection to minimize intraoperative bleeding.
The purpose of the present study was to investigate the angiographic appearance of a variety of spinal tumors, assess the safety and efficacy of preoperative embolization in relation to the amount of intraoperative blood loss, and correlate intraoperative tumor histology with the degree of gadolinium enhancement on spinal magnetic resonance imaging (MRI) and tumor vascularity visualized during angiography.
STUDY DESIGN/SETTING: Retrospective and single-institution cohort study.
One hundred four patients with spinal tumors referred for preoperative embolization.
Effectiveness of preoperative embolization in relation to intraoperative blood loss and number of transfused packed red blood cell units in perioperative period (72 hours).
From 2000 to 2009, 104 patients with spinal tumors underwent 114 spinal angiographies with the intent to embolize feeder vessels before surgery. The effectiveness of embolization was compared with the documented intraoperative blood loss. Angiographic tumor vascularity was graded from 0 (avascular) to 3 (highly vascular). Ninety-four patients had a pre- and post-gadolinium-enhanced MRI of the spine before transarterial embolization. Magnetic resonance imaging vascular enhancement was classified as Grade 3 (avid contrast enhancement), Grade 2 (moderate), or Grade 1 (mild).
Transarterial tumor embolization was angiographically complete in 63 (66%) and partial in 33 procedures (34%). In 18 cases, the target was not deemed suitable for embolization. A limited statistical analysis did not reveal a statistical difference in documented intraoperative blood loss between patients with complete versus partial embolization for the entire cohort or when stratified into renal cell carcinoma (RCC; p=.64), multiple myeloma (p=.28), malignant (p=.17) and benign tumor groups (p=.26). There were no clinical complications associated with embolization. There was poor correlation between MRI enhancement and angiographic vascularity.
Preoperative embolization was angiographically effective in most cases. Avid gadolinium enhancement (Grade 3) on MRI was not predictive of hypervascularity on angiography. Furthermore, hypervascularity was not restricted to classically vascular tumors, such as RCC, as it was noted in some patients with breast and prostate cancer. However, with the available numbers, the quality of preoperative embolization did not significantly affect intraoperative blood loss. A future prospective randomized controlled study may be warranted to better characterize the benefits of preoperative embolization for spinal tumors.
脊柱肿瘤患者在手术切除前通常会接受术前血管造影和栓塞，以减少术中出血。
本研究旨在探讨各种脊柱肿瘤的血管造影表现，评估术前栓塞在与术中出血量相关的安全性和有效性，并将术中肿瘤组织学与脊柱磁共振成像（MRI）上的钆增强程度以及血管造影术中观察到的肿瘤血管性相关联。
研究设计/机构：回顾性和单机构队列研究。
104 例因术前栓塞而转诊的脊柱肿瘤患者。
术前栓塞在与术中失血量和围手术期（72 小时）输血量相关方面的有效性。
2000 年至 2009 年，104 例脊柱肿瘤患者进行了 114 次脊柱血管造影术，目的是在手术前栓塞供血血管。将栓塞的效果与记录的术中出血量进行比较。血管造影肿瘤血管性从 0（无血管）到 3（高度血管）进行分级。94 例患者在经动脉栓塞前进行了脊柱的预增强和后增强磁共振成像（MRI）。磁共振成像血管增强分为 3 级（强烈对比增强）、2 级（中度）或 1 级（轻度）。
63 例（66%）完全栓塞，33 例（34%）部分栓塞。在 18 例病例中，目标被认为不适合栓塞。有限的统计分析显示，在整个队列中，完全栓塞与部分栓塞患者的术中出血量之间没有统计学差异，当分层为肾细胞癌（RCC；p=0.64）、多发性骨髓瘤（p=0.28）、恶性（p=0.17）和良性肿瘤组（p=0.26）时也没有统计学差异。栓塞没有引起临床并发症。MRI 增强与血管造影血管性之间相关性差。
术前栓塞在大多数情况下在血管造影上是有效的。MRI 上的强烈钆增强（3 级）不能预测血管造影上的高血管性。此外，高血管性不仅限于 RCC 等经典血管肿瘤，因为一些乳腺癌和前列腺癌患者也有这种情况。然而，根据现有的数字，术前栓塞的质量并没有显著影响术中出血量。未来可能需要进行前瞻性随机对照研究，以更好地描述术前栓塞对脊柱肿瘤的益处。
