Preoperative Transarterial Embolization of Spinal Tumor: Embolization Techniques and Results
Hai Bin Shi
,a,
Dae Chul Suha,
Ho Kyu Leea,
Soo Mee Lima,
Dae Hong Kima,
Choong Gon Choia,
Choon Sung Leea and
Seung Chul Rhima
a From the Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (H.B.S.); and the Departments of Diagnostic Radiology (D.C.S., H.K.L., S.M.L., D.H.K., C.G.C.), Orthopedic Surgery (C.S.L.), and Neurosurgery (S.C.R.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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FIG 1. Case 7: 27-year-old woman with a giant cell tumor in the L3 vertebral body who underwent embolization 2 days before surgery.
A, Preembolization angiogram of the right second lumbar artery shows hypervascular supply to the tumor.
B, Selective injection of the dorsispinal artery at L2 (arrow) shows the extraspinal longitudinal anastomoses from L1 to L4 with tumor supply by L2 and L3.
C, Superselective injection of the feeding artery near the dorsispinal branch was followed by infusion of PVA particles.
D, Postembolization angiogram shows nearly total occlusion of the feeding artery and patency of the normal branches.
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FIG 2. Case 10: 55-year-old man with a paraganglioma in the T12 vertebral body who underwent embolization 7 days before surgery.
A and B, Angiogram of the right segmental artery at T12 (A) and selective angiogram with microcatheter (B) show the posterior radiculomedullary artery (small arrows) originating from the same trunk as the feeding artery (large arrow) to the tumor.
C, Pedicular injection after superselective catheterization and infusion of PVA particles and Gelfoam pieces in the feeder show complete occlusion of the feeder (large arrow) and patency of the posterior radiculomedullary artery (small arrows).
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FIG 3. Case 6: 31-year-old man with an intramedullary hemangioblastoma at T8–T9 who underwent embolization the day before surgery.
A, Preembolization angiogram shows that the posterior radiculomedullary artery (arrow), mainly supplying the intradural tumor, originates from the right ninth intercostal artery.
B, Angiogram after embolization with coils (large arrow) shows occlusion of the intercostal artery distal to the feeder, and the presence of another normal branch originating just distal to the feeder. Infusion of PVA particles with preferential flow and infusion of Gelfoam was then performed through the microcatheter (small arrow) close to the feeder.
C, Postembolization angiogram shows complete occlusion of both the feeder and the normal branch.
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FIG 4. Case 1: 41-year-old woman with a meningioma at C1–C2 who underwent embolization the day before surgery.
A, Right vertebral angiogram before embolization shows a C2 branch supplying the intradural tumor (arrow).
B, Selective microcatheter injection of the common trunk of the feeder (large arrow) and the normal branch (small arrow) is performed before embolization.
C, Late arterial phase of selective injection shows that most of the contrast medium in the normal branch is washed out (small arrows) because the wedged microcatheter caused flow reversal in the branch. Note that dense contrast medium remains in the trunk (large arrow) just distal to the tip of the microcatheter.
D, Injection after infusion of PVA particles in the trunk shows almost complete occlusion of the feeder (large arrow) and patency of the normal branch (small arrows).
E, Right vertebral angiogram after embolization with Gelfoam pieces shows complete occlusion of both the feeder (large arrow) and the normal branch (small arrow).
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