Hypervascular Spinal Tumors: Influence of the Embolization Technique on Perioperative Hemorrhage
Joachim Berkefeld
,a,
Detlef Scalea,
Johannes Kirchnera,
Thomas Heinricha and
Jürgen Kollatha
a From the Institutes of Neuroradiology (J.B.) and Diagnostic Radiology (J.K., T.H., J.K.), and the Clinic of Orthopedics, Department of Spinal Diseases (D.S.), Frankfurt/Main, Germany.
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FIG 1. Diagram shows range of variation of intraoperative hemorrhage in corporectomy procedures according to embolization technique. Minimum, median, and maximum values of estimated blood loss are indicated for each group of patients
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FIG 2. Comparisons of estimated median blood loss and statistical significance (U test) of no vs coil (N.S.), coil vs particle-coil (P = .05), no vs particle-coil (P = .01), and no vs particle embolization (P = .01) are shown. No significant difference could be demonstrated between the two particle techniques. The table shows mean and median blood losses and the standard deviation. Additionally, the number of transfused units of packed red blood cells (300 ml each) is indicated
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FIG 3. The stages of a patient with renal cell carcinoma who underwent corporectomy 24 hours after embolization are shown.
A, Abdominal aortogram shows an angiomatous pattern of vascularization. A strong tumor blush and enlarged feeding segmental arteries are visible.
B, No residual tumor staining is visible after coil embolization with occlusion of the segmental pedicles at the level of L4 and L5 on both sides.
C, Twenty-four hours after embolization, the corporectomy procedure had to be interrupted because massive hemorrhage (6800 ml) occurred during preparation and stabilization. A control angiogram showed revascularization of the tumor through collateral branches of the iliolumbar truncus. After reembolization with PVA particles, the vertebral body replacement could be completed in a second session with a blood loss of 2200 ml.
D, A radiograph of the lumbar spine shows the dorsal and ventral internal fixation and the titanium basket in place.
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