Preoperative transarterial embolization of spinal column neoplasms

To determine the safety and value of vertebral column embolization before surgical resection of vascular neoplastic disease.

Thirty preoperative embolization procedures were performed in 20 patients with vascular neoplasms of the vertebral column (C-2 to sacrum). Fourteen patients had metastatic renal cell carcinoma. Distal embolic agents were used in 27 cases and were coupled with more proximal agents in six. Gelatin pledgets alone were used in three cases. Twenty-six of the 27 surgical procedures involved partial to complete tumor resection.

Seventy-two arteries were embolized (one to six per procedure). All surgical procedures were successful, and none were terminated because of blood loss. Massive blood loss occurred in one patient with paraganglioma, but embolization allowed complete vertebral resection at two levels. When this patient was excluded, blood loss ranged from 300 to 5,000 mL (mean, 1,871 mL). Transfusions required in 22 surgical procedures ranged from 1 to 10 units of packed red blood cells. Symptoms became worse after embolization in one case but improved with surgical decompression.

Embolization before surgery for spinal column neoplasms appears to safely and effectively limit blood loss.