Westbroek Erick M, Ahmed A Karim, Pennington Zach, Goodwin Matthew L, Xia Yuanxuan, Boone Christine, Gailloud Philippe, Sciubba Daniel M
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
World Neurosurg. 2019 Jun;126:e480-e485. doi: 10.1016/j.wneu.2019.02.075. Epub 2019 Feb 28.
Preoperative endovascular embolization of hypervascular metastatic spine tumors can reduce intraoperative blood loss. One frequent objection to embolizing these tumors is the concern for associated arteries feeding the spinal cord, such as the artery of Adamkiewicz. This study aimed to elucidate a relationship between spinal levels affected by hypervascular spine metastases and associated radiculomedullary arteries (RMAs).
A retrospective review of 46 patients who underwent preoperative embolization of hypervascular metastatic spine tumors was conducted. A total of 484 spinal levels were evaluated by diagnostic spinal angiography during embolization procedures. Each spinal level was categorized based on the presence or absence of tumor and RMA.
No statistically significant associations were found. The relative risk of affected spinal levels having an associated RMA was 1.10 (95% confidence interval, 0.66-1.85). The attributable risk was 0.01 (-0.01 to 0.02). Chi-squared statistic was 0.13, with a P value of 0.7. Subgroup analysis in renal cell patients was also statistically insignificant, with a relative risk of 0.97 (95% confidence interval, 0.43-2.16). Chi-square statistic was 0.01, with a P value 0.94. A total of 32 patients (69.6%) had an RMA identified on their regional angiogram. Seventeen patients (37%) had an RMA at an embolized level.
In this study, no association was found between spinal levels affected by hypervascular metastatic spine tumors and RMAs feeding the spinal cord by diagnostic spinal angiography. This suggests that these tumors have little intrinsic affinity for spinal levels with an RMA. However, given that tumor embolization frequently requires accessing multiple levels, the risk of encountering an RMA during embolization remains significant.
术前对富血管性脊柱转移瘤进行血管内栓塞可减少术中失血。对这些肿瘤进行栓塞的一个常见顾虑是担心有向脊髓供血的相关动脉，如Adamkiewicz动脉。本研究旨在阐明富血管性脊柱转移瘤所累及的脊髓节段与相关的神经根脊髓动脉（RMA）之间的关系。
对46例行富血管性脊柱转移瘤术前栓塞的患者进行回顾性研究。在栓塞过程中通过诊断性脊髓血管造影对总共484个脊髓节段进行评估。根据有无肿瘤和RMA对每个脊髓节段进行分类。
未发现有统计学意义的关联。受累脊髓节段伴有RMA的相对风险为1.10（95%置信区间，0.66 - 1.85）。归因风险为0.01（-0.01至0.02）。卡方统计量为0.13，P值为0.7。肾细胞癌患者的亚组分析也无统计学意义，相对风险为0.97（95%置信区间，0.43 - 2.16）。卡方统计量为0.01，P值为0.94。共有32例患者（69.6%）在其区域血管造影中发现有RMA。17例患者（37%）在栓塞节段有RMA。
在本研究中，通过诊断性脊髓血管造影未发现富血管性脊柱转移瘤所累及的脊髓节段与向脊髓供血的RMA之间存在关联。这表明这些肿瘤对伴有RMA的脊髓节段几乎没有内在亲和力。然而，鉴于肿瘤栓塞通常需要处理多个节段，栓塞过程中遇到RMA的风险仍然很大。
