Preoperative Onyx embolization of hypervascular head, neck, and spinal tumors. Experience with 100 consecutive cases from a single tertiary center

Study Design: Retrospective cohort study. Objective: To evaluate the clinical efficacy of minimally invasive endoscopic surgery in patients with spinal extradural and intradural-extramedullary tumors. Methods: This was a study of 15 consecutive patients with spinal extradural or intradural-extramedullary tumors up to 2 levels treated by minimal invasive surgery using a full endoscopic visualization and Caspar’s retraction system (for cervical, thoracic, and lumbar tumors) over a 4-year period between January 2015 to April 2019 at a tertiary center. Results: A gross total remove was achieved in all patients (100%), determined by postoperative contrast computed tomography scans and magnetic resonance imaging. There was no postoperative spinal instability. All patients had equal or better neurologic functions after surgery at follow-up. The average preoperative Nurick’s grade mean was 1.9 and the postoperative was 1.1. The average preoperative McCormick’s grade mean was 2.9 versus 1.3 in the postoperative period. Conclusions: Selective extradural or intradural-extramedullary tumors well localized and up to 2 levels can be safely and effectively treated by minimally invasive surgery using a full endoscopic visualization and the Caspar’s retractor. However, there is insufficient evidence to recommend this approach over the classical or other microsurgical approach described.

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COMPLICATIONS AFTER PARTIAL, TOTAL OR EXTENDED SACRECTOMY: A CASE SERIES

Coluna/Columna ◽

10.1590/s1808-185120212003235738 ◽

2021 ◽

Vol 20 (3) ◽

pp. 229-231

Author(s):

DANILO DE SOUZA FERRONATO ◽

MAURO COSTA MORAIS TAVARES JUNIOR ◽

DOUGLAS KENJI NARAZAKI ◽

CESAR SALGE GHILARDI ◽

WILLIAM GEMIO JACOBSEN TEIXEIRA ◽

...

Keyword(s):

Perioperative Complications ◽

Case Series ◽

Hemodynamic Instability ◽

Spinal Tumors ◽

Posterior Fixation ◽

High Morbidity ◽

Hospitalization Time ◽

Case Series Study ◽

Tertiary Center ◽

The Mean

ABSTRACT Objective The aim of this study was to conduct a survey of the different complications of partial, total or extended sacrectomy for the treatment of spinal tumors. Method This study is a descriptive analysis of medical records from a series of 18 patients who underwent sacrectomy between 2010 and 2019 at a tertiary center specializing in spinal tumor surgeries. The variables analyzed were sex, age, hospitalization time, oncologic diagnosis, posterior fixation pattern, rate of complications, and Frankel, ASA and ECOG scales. Results Of the 18 patients, 10 (55.5%) were male and 8 (44.5%) were female, and the mean age was 48 years. The mean hospitalization time was 23 days. Of the 18 patients, 8 (44.5%) contracted postoperative infections requiring surgery. Perioperative complications included liquoric fistula (22.25%), hemodynamic instability requiring vasoactive drugs in the immediate postoperative period (22.25%), wound dehiscence (11.1%), acute obstructive abdomen (11.1%), occlusion of the left external iliac artery (11.1%), immediate postoperative death due to acute myocardial infarction (11.1%), and intraoperative death due to hemodynamic instability (11.1%). Conclusions Partial, total or extended sacrectomy is a complex procedure with high morbidity and mortality, even in centers specializing in the treatment of spinal tumors. Level of evidence IV; case series study.

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Safety and efficacy of vascular tumor embolization using Onyx: is angiographic devascularization sufficient?

Journal of Neurosurgery ◽

10.3171/2009.7.jns09351 ◽

2010 ◽

Vol 112 (5) ◽

pp. 1039-1045 ◽

Cited By ~ 41

Author(s):

Mohamed Samy Elhammady ◽

Stacey Quintero Wolfe ◽

Ramsey Ashour ◽

Hamad Farhat ◽

Roham Moftakhar ◽

...

Keyword(s):

Blood Loss ◽

Vascular Tumor ◽

Spinal Tumors ◽

Vascular Tumors ◽

Embolic Material ◽

Safety And Efficacy ◽

Tumor Embolization ◽

The Mean ◽

Tumor Bleeding ◽

Head Neck

Object The authors assessed the safety and efficacy of embolization of head, neck, and spinal tumors with Onyx and determined the correlation between tumor embolization and intraoperative blood loss. Methods The authors prospectively collected all head, neck, and spinal tumors embolized with Onyx at their institution over a 28-month period. Information on tumor type, location, extent of tumor devascularization, endovascular and surgical complications, and intraoperative estimated blood loss (EBL) was evaluated. Results Forty-three patients with various head, neck, and spinal lesions underwent vascular tumor embolization with Onyx. Indications for embolization included uncontrolled tumor bleeding in 8 cases, elective preoperative devascularization in 34, and tumor-induced consumptive thrombocytopenia in 1 case. Embolization was performed via direct tumoral puncture in 14 cases and through the traditional transarterial route in the remaining lesions. Embolization was successful in ending uncontrolled tumor bleeding in all 8 cases and in reversing the consumptive coagulopathy in 1 case. Intraparenchymal penetration of embolic material was possible in all percutaneously embolized tumors and in 4 of the 20 tumors embolized preoperatively via the transarterial route. The mean percentage of devascularization in tumors with intraparenchymal penetration of Onyx was 90.3% compared with 83.7% in tumors without intraparenchymal penetration. The mean EBL with intraparenchymal penetration of Onyx was significantly lower than when there was no intraparenchymal penetration (459 vs 2698 ml; p = 0.0067). There were no neurological complications related to the embolization procedures. Conclusions Embolization of vascular tumors with Onyx can be performed safely but may not reach optimal effectiveness in reducing intraoperative EBL if the embolic material does not penetrate the tumor vasculature. In the authors' experience, the best method of intraparenchymal penetration is achieved with direct tumor puncture. Transarterial embolization may not result in tumor penetration, particularly when injected from a long distance through small caliber or slow flow vessels.

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