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AJNR - American Journal of Neuroradiology

Published ahead of print on March 27, 2008
doi: 10.3174/ajnr.A1010

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Preoperative Onyx Embolization of Aggressive Vertebral Hemangiomas

M.C. Hurley^a,b, B.A. Gross^b, D. Surdell^a,b, A. Shaibani^a,b, K. Muro^b, C.M. Mitchell^c, E.M. Doppenberg^d and B.R. Bendok^a,b

^a Department of Radiology, Feinberg School of Medicine and McGaw Medical Center, Northwestern University, Chicago, Ill
^b Department of Neurological Surgery, Feinberg School of Medicine and McGaw Medical Center, Northwestern University, Chicago, Ill
^c Department of Pathology, Evanston Hospital, Chicago, Ill
^d Department of Neurosurgery, Evanston Hospital, Chicago, Ill

View larger version (101K): [in this window] [in a new window]   Fig 1. A, Noncontrast CT demonstrates mixed trabecular and lytic infiltration of the L2 vertebra by a soft tissue mass, expanding the right pedicle and extending into paravertebral soft tissues (arrows). B, Postgadolinium T1 fat-sat coronal demonstrates the avidly enhancing, lobulated mass (arrowheads) with prominent flow voids. Note enhancement of the cauda equina below the level of compression (arrows).

View larger version (191K): [in this window] [in a new window]   Fig 2. A, Selective angiography of the left L2 lumbar artery shows prominent tumor vascularity. No spinal anastomoses were identified. Note inferior vena-cava filter and diagnostic catheter in situ (arrow). B, Post-Embosphere-embolization angiography via the Prowler microcatheter (Cordis) (arrowhead) reveals persistent tumor enhancement. C, Note the guide catheter (arrow) after Onyx embolization, where the artery is occluded but the agent is largely restricted to the main artery (extending from arrowhead to arrow). D, Plain anterior/posterior radiograph shows distribution of the 4 Onyx embolizations. Note extension of Onyx from the proximal left L1 lumbar artery (arrowhead) inferior to L2 and then across the midline (arrows).

View larger version (96K): [in this window] [in a new window]   Fig 3. Immediate postembolization axial noncontrast CT (A) and coronal reformat (B) show penetration of Onyx through tumor vessels within the vertebral body.

View larger version (85K): [in this window] [in a new window]   Fig 4. Postembolization frontal radiograph of the T8 vertebra (A) shows Onyx distributed diffusely through the midlateral and right-lateral vertebral body, extending into the right pedicle (arrowhead). Note tip of Cobra catheter (Merit Medical Systems, South Jordan, Utah) (double arrowheads) and microcatheter positioned in tumor feeder (arrow). Noncontrast CT through T8 shows that the Onyx also extends into the epidural portion of the mass (arrow). Note coils positioned more distally in the right T8 intercostal artery (arrowhead).

View larger version (106K): [in this window] [in a new window]   Fig 5. Gross (A) and microscopic (B) images of postresection specimen show Onyx filling the vascular channels of the hemangioma.