Preoperative Embolization of Metastatic Spinal Cord Compression with n-Butyl Cyanoacrylate: Safety and Effectiveness in Limiting Blood Loss

Triple coaxial microcatheter for preoperative transcatheter arterial embolization in bone and soft tissue tumors

BACKGROUND

Preoperative transcatheter arterial embolization (P-TAE) is a procedure designed to reduce intraoperative blood loss (IBL) and support the performance of surgery for bone and soft tissue tumors (BSTT).

PURPOSE

To develop a new P-TAE technique using a triaxial microcatheter system (TMCS) that maintains normal tissue circulation while embolizing only the feeding artery of BSTT and to investigate the safety and efficacy of P-TAE with TMCS.

MATERIAL AND METHODS

A total of 34 cases of BSTT in the whole body (25 men, nine women; mean age = 74.85 ± 11.32 years) were included between 1 April 2014 and 30 June 2024. We evaluated technical and clinical outcomes, P-TAE techniques, complications, and patient characteristics.

RESULTS

Bone metastasis of renal cell carcinoma (n = 11) was the most frequent diagnosis. P-TAEs using TMCS were performed with technical success (97.05%) and clinical success (88.23%), demonstrating a high selectivity rate to the feeding artery of 97.14%. The mean IBL was 792.70 ± 1285.61 mL (median = 370 mL; range = 50-6935 mL). All surgeries were performed successfully after P-TAE.

CONCLUSION

P-TAE plays an important role in the presurgical operation of BSTT. The use of TMCS offers high selectivity, trackability, and crossability in the P-TAE procedure, enhancing the clinical efficacy of P-TAE.

Refinement of nBCA embolization technique in treatment of metastatic spinal tumors: Case series and technical report

BACKGROUND AND OBJECTIVES

Preoperative embolization of metastatic spinal tumors (MSTs) has proven advantageous in limiting intraoperative blood loss (IBL) during resection. N-butyl cyanoacrylate (nBCA) is a liquid embolic agent known for its rapid hemostatic effects. However, nBCA is associated with a higher risk of distal nontarget embolization. This study highlights the refinement of the embolization technique and assesses its efficacy in performing an initial distal segmental artery plug with concentrated nBCA followed by proximal diluted nBCA for MSTs.

METHODS

A retrospective review of patients with MST (2018-2023) was performed. Patients who underwent preoperative nBCA endovascular embolization prior to tumor resection and spinal instrumentation were included. Baseline standard spinal angiography was performed.

RESULTS

Sixteen patients (13 men, 3 women; 56.0 ± 12.4 years) met inclusion criteria. And 43.75% (7 of 16) had thoracic levels, 37.5% (6 of 16) lumbar, and 18.75% (3 of 16) sacral. The most common primary tumor was renal cell carcinoma (43.75%, 7 of 16). A total of 43 pedicles were embolized (median 3), resulting in complete/near complete obliteration of the tumor blush. Most pedicles (83.7%, 36 of 43) received a single dilute concentration of nBCA; however, 16.3% (7 of 43) received two separate concentrations of nBCA, a denser concentration distally into the segmental artery and a diluted concentration proximally into the tumor bed. Mean IBL was 1150 ± 1201 mL in 3 distal plug patients distal plug patients versus 1625 ± 681 mL in 12 other patients. There were no complications related to embolization.

CONCLUSION

Performing a distal, concentrated nBCA plug during preoperative nBCA embolization of MSTs may increase tumor penetration and reduce IBL.