Spinal metastases from renal cell carcinoma: Effect of preoperative particle embolization on intraoperative blood loss

BACKGROUND AND PURPOSE: Surgical repair of spinal metastases from renal ori gin is often complicated by excessive bleeding. The purpose of this study w as to assess the effect of preoperative particulate embolization on intraop erative blood loss. METHODS: Twenty spinal metastases from renal origin (17 patients) treated b y preoperative embolization with polyvinyl alcohol particles were analyzed retrospectively. Surgical decompression was performed within 2 days after e mbolization. A control group of 10 patients with 11 spinal metastases of re nal origin underwent surgery without embolization, The effect of preoperati ve embolization, of completeness of embolization, and of particle size on t he estimated intraoperative blood loss was analyzed using nonparametric sta tistical tests. RESULTS: Complete embolization was achieved in 10 cases and partial emboliz ation in the other 10, The estimated blood loss of 19 embolized and II cont rol cases was available from the surgical report. Median intraoperative blo od loss in 19 embolized lesions was 1500 mt (range, 300-8000 mL), compared with 5000 mt (range, 1440-15000 mt) in the control group. Even after partia l embolization, blood loss (median, 2000 mt) was significantly lower than i n the control group. No significant differences in estimated blood loss wer e noted between the use of particles smaller than 250 mum and those larger than 250 mum. No embolization-related permanent neurologic deficit or skin or muscle necrosis occurred. CONCLUSION: Preoperative embolization of spinal metastases of renal origin with polyvinyl alcohol particles is safe and might reduce intraoperative bl ood loss significantly. Even partial embolization seems to be effective.