title: Onyx injection by direct puncture for the treatment of hypervascular spinal metastases close to the anterior spinal artery: initial experience.
abstract: Presurgical devascularization of hypervascular spinal metastases has been shown to be effective in preventing major blood loss during open surgery. Most often, embolization can be performed using polyvinyl alcohol (PVA) microparticles. However, in some cases, the close relationship between the feeders of the metastases and the feeders of the anterior spinal artery (ASA) poses a risk of spinal cord ischemia when PVA microparticle embolization is performed. The authors present their early experience in the treatment of spinal metastases close to the ASA; in 2 cases they injected Onyx-18, by direct puncture, into hypervascular posterior arch spinal metastases situated close to the ASA. Two women, one 36 and the other 55 years of age, who presented with spinal lesions (at the posterior arch of C-4 and T-6, respectively) from thyroid and a kidney tumors, were sent to the authors' department to undergo presurgical embolization. After having performed a complete spinal digital subtraction angiography study, a regular angiography catheter was positioned at the ostium of the artery that mainly supplied the lesion. Then, with the patient in the left lateral decubitus position, direct puncture with 18-gauge needles of the lesion was performed using roadmap guidance. Onyx-18 was injected through the needles under biplanar fluoroscopy. Satisfactory devascularization of the lesions was obtained; the ASA remained patent in both cases. The metastases were surgically removed in both cases within the 48 hours after the embolization and major blood loss did not occur. Presurgical devascularization of hypervascular spinal metastases close the ASA by direct puncture with Onyx-18 seems to be an effective technique and appears to be safe in terms of the preserving the ASA's patency.
authors.affiliation: Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France. fredclare5@msn.com
authors.forename: Frédéric
authors.initials: F
authors.lastname: Clarençon
authors.forename: Federico
authors.initials: F
authors.lastname: Di Maria
authors.forename: Evelyne
authors.initials: E
authors.lastname: Cormier
authors.forename: Nader-Antoine
authors.initials: NA
authors.lastname: Sourour
authors.forename: Eric
authors.initials: E
authors.lastname: Enkaoua
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sailhan
authors.forename: Christina
authors.initials: C
authors.lastname: Iosif
authors.forename: Lise
authors.initials: L
authors.lastname: Le Jean
authors.forename: Jacques
authors.initials: J
authors.lastname: Chiras
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D002574:Cervical Vertebrae / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D004338:Drug Combinations; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007267:Injections / Q000379:methods; D008875:Middle Aged; D011145:Polyvinyls / Q000008:administration & dosage*; D011300:Preoperative Care / Q000379:methods; D013125:Spinal Neoplasms / Q000098:blood supply* / Q000601:surgery; D013635:Tantalum / Q000008:administration & dosage*; D013904:Thoracic Vertebrae / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000187:drug effects*
chemical_list: D004338:Drug Combinations; C558446:Onyx 18; D011145:Polyvinyls; D013635:Tantalum