Hypervascular spinal tumors: Influence of the embolization technique on perioperative hemorrhage

BACKGROUND AND PURPOSE: Corporectomy is an effective treatment for vertebra l metastases; however, massive perioperative hemorrhage is often associated with this procedure. We compared preoperative particle, particle-coil, and coil embolizations of hypervascular spinal tumors prior to vertebral body replacement to determine which prevented perioperative hemorrhage most effe ctively. METHODS: The vertebral tumors of 59 patients were embolized prior to corpor ectomy, In 26 cases, only coils were used for the proximal occlusion of fee ding segmental arteries. Twenty-four patients received a combination of pol yvinyl alcohol (PVA) particles and coils, and nine tumors were embolized wi th particles alone. We compared intraoperative blood loss between the three groups and 10 other patients who did not undergo embolization prior to cor porectomy, RESULTS: Estimation of intraoperative hemorrhage showed a median value of 4 350 mL in patients without embolization, 2650 mL in cases of coil embolizat ion, 1850 mL in cases of particle-coil embolization, and 1800 mL in cases o f particle embolization, The difference between unembolized patients and th ose who underwent coil embolization was not statistically significant. Part icle and particle-coil embolizations showed very similar results, and reduc ed hemorrhage significantly as compared to unembolized and proximal coil oc clusion cases, Residual bleeding came from the venous system and the neighb orhood of the embolized region. CONCLUSION: Particle embolization prior to corporectomy can reduce perioper ative hemorrhage, The additional benefit of proximal coil occlusion of arte rial feeders is questionable.