Comparison of complete and near-complete endovascular embolization of hypervascular spine tumors with partial embolization

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  • 1 Departments of Neurosurgery and
  • 3 Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
  • 2 Department of Interventional Radiology, University of California, San Diego School of Medicine, San Diego, California
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OBJECTIVE

Preoperative endovascular embolization of hypervascular spine tumors can reduce intraoperative blood loss. The extent to which subtotal embolization reduces blood loss has not been clearly established. This study aimed to elucidate a relationship between the extent of preoperative embolization and intraoperative blood loss.

METHODS

Sixty-six patients undergoing preoperative endovascular embolization and subsequent resection of hypervascular spine tumors were retrospectively reviewed. Patients were divided into 3 groups: complete embolization (n = 22), near-complete embolization (≥ 90% but < 100%; n = 22), and partial embolization (< 90%; n = 22). Intraoperative blood loss was compared between groups using one-way ANOVA with post hoc comparisons between groups.

RESULTS

The average blood loss in the complete embolization group was 1625 mL. The near-complete embolization group had an average blood loss of 2021 mL in surgery. Partial embolization was associated with a mean blood loss of 4009 mL. On one-way ANOVA, significant differences were seen across groups (F-ratio = 6.81, p = 0.002). Significant differences in intraoperative blood loss were also seen between patients undergoing complete and partial embolization (p = 0.001) and those undergoing near-complete and partial embolization (p = 0.006). Pairwise testing showed no significant difference between complete and near-complete embolization (p = 0.57). Analysis of a combined group of complete and near-complete embolization also showed a significantly decreased blood loss compared with partial embolization (p < 0.001). Patient age, tumor size, preoperative coagulation parameters, and preoperative platelet count were not significantly associated with blood loss.

CONCLUSIONS

Preoperative endovascular embolization is associated with decreased intraoperative blood loss. In this series, blood loss was significantly less in surgeries for tumors in which preoperative complete or near-complete embolization was achieved than in tumors in which preoperative embolization resulted in less than 90% reduction of tumor vascular blush. These findings suggest that there may be a critical threshold of efficacy that should be the goal of preoperative embolization.

ABBREVIATIONS NBCA = N-butyl cyanoacrylate.

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Contributor Notes

Correspondence Daniel M. Sciubba: Johns Hopkins University School of Medicine, Baltimore, MD. dsciubb1@jhmi.edu.

INCLUDE WHEN CITING Published online April 3, 2020; DOI: 10.3171/2020.1.SPINE191337.

Disclosures Dr. Gailloud: consultant for Longeviti Neuro Solutions and Cerovenus, support of non–study-related clinical or research effort from Siemens Medical, direct stock ownership in Artventi, and Grant funding from DePuy Synthes. Dr. Sciubba: consultant for Baxter, DePuy Synthes, Globus Medical, K2M, Medtronic, NuVasive, Stryker; and unrelated grant support from Baxter Medical, North American Spine Society, Stryker.

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