title: Minimizing bleeding complications in spinal tumor surgery with preoperative Onyx embolization via dual-lumen balloon catheter.
abstract: BACKGROUND
  Intraoperative bleeding is a significant risk in surgery for highly vascular spinal tumors, but preoperative embolization can safely decrease intraoperative blood loss in extrinsic spine tumors. Onyx, widely used for cerebrovascular embolization, has been increasingly used as an embolic agent for preoperative spinal tumor embolization. The Scepter catheter, a dual-lumen balloon catheter, may improve tumor parenchymal penetration without the danger and limitations of significant embolic reflux. This may reduce bleeding risk during spinal surgery.
  
  
  METHODS
  Eleven consecutive cases of preoperative Onyx embolization of extrinsic spinal tumors were identified, all of whom had subsequent spinal surgery. Demographic data and clinical variables were collected. Patients were divided into Scepter (n=6) and non-Scepter (n=5) groups. The Mann-Whitney U test was used to compare continuous outcome variables and the Fisher exact test was used to compare categorical variables.
  
  
  RESULTS
  Estimated blood loss in the Scepter group was significantly lower than in the non-Scepter group (584±124 vs 2400±738 mL, p=0.004). The volume of intraoperative transfusion was also significantly lower (1.2±0.4 vs 5.8±1.7 units, p=0.004). There was no significant difference in the number of vessels embolized, vials of Onyx used, use of coiling adjunct, contrast load, radiation dose, or fluoroscopy time per pedicle (p>0.05).
  
  
  CONCLUSIONS
  The addition of the Scepter catheter to preoperative Onyx embolization is safe and feasible. In this small series, the Scepter catheter was associated with a reduction of intraoperative bleeding by 76% and a 79% lower transfusion volume. This was not accompanied by any unwanted increase in vials of Onyx used, contrast load, radiation dose, or fluoroscopy time.
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Travis R
authors.initials: TR
authors.lastname: Ladner
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Lucy
authors.initials: L
authors.lastname: He
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Nikita
authors.initials: N
authors.lastname: Lakomkin
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Davis
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Cheng
authors.affiliation: Department of Orthopedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: J
authors.initials: J
authors.lastname: Mocco
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D057785:Catheters; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage*; D004338:Drug Combinations; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011145:Polyvinyls / Q000008:administration & dosage*; D013125:Spinal Neoplasms / Q000628:therapy*; D013635:Tantalum / Q000008:administration & dosage*
chemical_list: D004338:Drug Combinations; C558446:Onyx 18; C000598428:Onyx 34; D011145:Polyvinyls; D013635:Tantalum; D004121:Dimethyl Sulfoxide
keywords: Catheter; Liquid Embolic Material; Spine; Tumor