title: Transpedicular N-butyl cyanoacrylate-mediated percutaneous embolization of symptomatic vertebral hemangiomas.
abstract: OBJECTIVE
  The resection of spinal hemangiomas is often challenging because of characteristic high-volume and potentially prohibitive intraoperative blood loss. Although transarterial embolization can mitigate this risk, it can be suboptimal when tumor arterial supply is diffuse or poorly defined. The authors present their experience in the use of preoperative percutaneous direct injection of spinal hemangiomas with N-butyl cyanoacrylate (NBCA) as an effective preoperative adjunct that may reduce operative blood loss and facilitate resection of these vascular tumors.
  
  
  METHODS
  Four patients with symptomatic spinal hemangiomas were treated using percutaneous transpedicular direct NBCA-Lipiodol injection; 2 patients had undergone prior spinal angiography, with suboptimal transarterial embolization in 1. Each patient underwent percutaneous bilateral transpedicular NBCA-assisted tumor embolization prior to resection. Retrospective analysis of operative times, blood loss, and clinical data is presented.
  
  
  RESULTS
  There were no complications associated with the percutaneous NBCA embolization technique. The procedure was effective at facilitating tumor removal and minimizing intraoperative blood loss, especially at the vertebral body resection stage. Improved tumor filling was achieved as the filling characteristics of dilute NBCA-Lipiodol mixture within large-channel, high-flow hemangiomas were appreciated with experience.
  
  
  CONCLUSIONS
  Transpedicular NBCA direct-puncture embolization of spinal hemangiomas is an effective preoperative adjunct that facilitates resection of these highly vascular tumors. It is particularly useful when transarterial embolization is unsafe or suboptimal due to constraints imposed by the local angioarchitecture.
authors: Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York, USA.
authors: Kevin C
authors: KC
authors: Yao
authors: Adel M
authors: AM
authors: Malek
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D004659:Enbucrilate / Q000008:administration & dosage*; D004998:Ethiodized Oil / Q000008:administration & dosage*; D005260:Female; D006391:Hemangioma / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D013125:Spinal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D013908:Thoracotomy; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D004998:Ethiodized Oil; D004659:Enbucrilate