Nair Sreejit, Gobin Y Pierre, Leng Lewis Z, Marcus Joshua D, Bilsky Mark, Laufer Ilya, Patsalides Athos
Department of Radiology, Weill Cornell Medical College, New York Presbyterian Hospital; New York, NY, USA - E-mail:
Interv Neuroradiol. 2013 Sep;19(3):377-85. doi: 10.1177/159101991301900317. Epub 2013 Sep 26.
The existing literature on preoperative spine tumor embolization is limited in size of patient cohorts and diversity of tumor histologies. This report presents our experience with preoperative embolization of hypervascular thoracic, lumbar, and sacral spinal column tumors in the largest series to date. We conducted a retrospective review of 228 angiograms and 188 pre-operative embolizations for tumors involving thoracic, lumbar and sacral spinal column. Tumor vascularity was evaluated with conventional spinal angiography and was graded from 0 (same as normal adjacent vertebral body) to 3 (severe tumor blush with arteriovenous shunting). Embolic materials included poly vinyl alcohol (PVA) particles and detachable platinum coils and rarely, liquid embolics. The degree of embolization was graded as complete, near-complete, or partial. Anesthesia records were reviewed to document blood loss during surgery. Renal cell carcinoma (44.2%), thyroid carcinoma (9.2%), and leiomyosarcoma (6.6%) were the most common tumors out of a total of 40 tumor histologies. Hemangiopericytoma had the highest mean vascularity (2.6) of all tumor types with at least five representative cases followed by renal cell carcinoma (2.0) and thyroid carcinoma (2.0). PVA particles were used in 100% of cases. Detachable platinum coils were used in 51.6% of cases. Complete, near-complete, and partial embolizations were achieved in 86.1%, 12.7%, and 1.2% of all cases, respectively. There were no new post-procedure neurologic deficits or other complications with long-term morbidity. The mean intra-operative blood loss for the hypervascular tumors treated with pre-operative embolization was 1745 cc. Preoperative embolization of hypervascular thoracic, lumbar, and sacral spine tumors can be performed with high success rates and a high degree of safety at high volume centers.
现有关于术前脊柱肿瘤栓塞的文献在患者队列规模和肿瘤组织学多样性方面存在局限性。本报告介绍了我们在迄今为止最大规模系列中对高血供胸段脊柱、腰段脊柱和骶骨脊柱肿瘤进行术前栓塞的经验。我们对228例血管造影和188例涉及胸段、腰段和骶骨脊柱肿瘤的术前栓塞进行了回顾性研究。采用传统脊柱血管造影评估肿瘤血管情况，并将其从0级（与相邻正常椎体相同）分级至3级（伴有动静脉分流的严重肿瘤染色）。栓塞材料包括聚乙烯醇（PVA）颗粒、可脱性铂线圈，很少使用液体栓塞剂。栓塞程度分为完全栓塞、近完全栓塞或部分栓塞。回顾麻醉记录以记录手术期间的失血量。在总共40种肿瘤组织学类型中，肾细胞癌（44.2%）、甲状腺癌（9.2%）和平滑肌肉瘤（6.6%）是最常见的肿瘤。在所有肿瘤类型中，血管外皮细胞瘤的平均血管分级最高（2.6级），至少有5例代表性病例，其次是肾细胞癌（2.0级）和甲状腺癌（2.0级）。所有病例中100%使用了PVA颗粒。51.6%的病例使用了可脱性铂线圈。所有病例中分别有86.1%、12.7%和1.2%实现了完全栓塞、近完全栓塞和部分栓塞。术后未出现新的神经功能缺损或其他长期发病的并发症。术前栓塞治疗的高血供肿瘤术中平均失血量为1745毫升。在大型中心，高血供胸段、腰段和骶骨脊柱肿瘤的术前栓塞可以高成功率和高度安全性进行。
