title: Permanent endovascular balloon occlusion of the vertebral artery as an adjunct to the surgical resection of selected cervical spine tumors: A single center experience.
abstract: OBJECTIVE
  Complete surgical resection of cervical spine tumors is often challenging when there is tumor encasement of major neck vessels. Pre-operative endovascular sacrifice of the major vessels can facilitate safe tumor resection. The use of transarterial detachable coils has been described in this setting, but it can be time-consuming and costly to occlude a patent parent vessel using this method. Our aim was to evaluate the safety and effectiveness of our endovascular detachable balloon occlusion technique, performed without prior balloon test occlusion in the pre-operative management of these tumors.
  
  
  METHODS
  We retrospectively reviewed 18 consecutive patients undergoing pre-operative unilateral permanent endovascular balloon occlusion of tumor-encased vertebral arteries in our institution. Procedure-related ischemic or thromboembolic complication was defined as focal neurologic deficit attributable to the endovascular occlusion which occurs before subsequent surgical resection.
  
  
  RESULTS
  Successful pre-operative endovascular vertebral artery sacrifice using detachable balloons was achieved in 100% (n = 18) of cases without prior balloon test occlusion. Procedural complication rate was 5.6% as one patient developed transient focal neurology secondary to a delayed cerebellar infarct at home on day 11 and subsequently made a full recovery. There were no cases of distal balloon migration. Complete macroscopic resection of tumor as reported by the operating surgeon was achieved in 89% of cases.
  
  
  CONCLUSIONS
  Pre-operative endovascular sacrifice of the vertebral artery using detachable balloons and without prior balloon test occlusion is a safe procedure with low complication rates and good surgeon reported rates of total resection.
authors.affiliation: National Hospital for Neurology and Neurosurgery, London, UK mduaoi@doctors.org.uk.
authors.forename: Ayokunle
authors.initials: A
authors.lastname: Ogungbemi
authors.affiliation: National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: Vivien
authors.initials: V
authors.lastname: Elwell
authors.affiliation: National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Choi
authors.affiliation: National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: Fergus
authors.initials: F
authors.lastname: Robertson
mesh_terms: D000328:Adult; D021721:Balloon Occlusion / Q000379:methods*; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000209:etiology; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D003430:Cross-Sectional Studies; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
keywords: Interventional; Neuroimaging; Spine; endovascular