title: Preoperative spinal tumor embolization: an institutional experience with Onyx.
abstract: BACKGROUND
  Preoperative embolization has the potential to decrease intraoperative blood loss and facilitate spinal cord decompression and tumor resection.
  
  
  OBJECTIVE
  We report our institutional experience with the embolization of hypervascular extradural spinal tumors with Onyx as well as earlier embolic agents in a series of 28 patients.
  
  
  METHODS
  A retrospective case review was conducted on patients undergoing preoperative transarterial embolization of a spinal tumor between 1995 and 2012 at our institution.
  
  
  RESULTS
  Twenty-eight patients met the inclusion criteria, with a mean age of 60.6 years. Twenty-eight patients had metastatic tumors. In 14 (50%) patients the metastases were from renal cell carcinomas. Fifty-four vessels were embolized using PVA, NBCA, Onyx, coils, or embospheres. Sixteen patients were treated with Onyx, 6 patients with PVA, 3 patients with embospheres, 2 patients with NBCA, and 3 patients with a combination of embolic agents. The average decrease in tumor blush was 97.8% with Onyx versus 92.7% with the rest of the embolic agents (p=0.08). The estimated blood loss was 1616ml (range 350-5000ml). Blood loss was 750cm(3) on average with Onyx versus 1844 with the rest of the embolic agents (p=0.14). The mean length of stay was 16 days. The mortality rate was zero. Pre- and post-operative modified Rankin Score (mRS) did not differ significantly in the series (3.12 versus 3.10, respectively, p=0.9).
  
  
  CONCLUSIONS
  In our experience, the use of transarterial tumor embolization as an adjunct for spinal surgery is a safe and feasible option.
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, USA.
authors.forename: George M
authors.initials: GM
authors.lastname: Ghobrial
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.forename: James
authors.initials: J
authors.lastname: Harrop
authors.forename: Richard T
authors.initials: RT
authors.lastname: Dalyai
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: David
authors.initials: D
authors.lastname: Hasan
authors.forename: Robert H
authors.initials: RH
authors.lastname: Rosenwasser
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D003131:Combined Modality Therapy; D004338:Drug Combinations; D004621:Embolization, Therapeutic; D015174:Epidural Neoplasms / Q000473:pathology / Q000556:secondary; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011145:Polyvinyls / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D013635:Tantalum / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D004338:Drug Combinations; C558446:Onyx 18; D011145:Polyvinyls; D013635:Tantalum
keywords: Endovascular; Epidural metastasis; Onyx; Preoperative adjunct; Spine tumor