Presurgical embolization of spinal tumours using glubran 2 acrylic glue

Effects of Glubran Acrylic Glue on the Subarachnoid Surface in Swine

Glubran2 is a cyanoacrylate-based synthetic glue modified by addition of a second monomer. Among its many advantages over traditional cyanoacrylate products, Glubran2 has a much lower thermal polymerization temperature than that of cyanoacrylates used for cutaneous application. For many years, the new glue has been widely used in neuroradiology endovascular treatments. Our study aimed to assess the use of Glubran2 to treat possible complications arising during the embolization of aneurysms or vascular malformations like AVM or fistulae. A complication encountered in some of these cases is rupture of the vessel wall by the microguide or perforation of the aneurysmal sac by the coils used for embolization. This complication could be overcome by injecting Glubran2 into the rupture point but this would put the glue directly in contact with the subarachnoid space and possibly reach adjacent brain tissue. The aim of this experimental study was to place the glue in direct contact with brain tissue to ascertain its immediate compatibility and tolerability in vivo and any ensuing tissue damage. Three swine underwent neurosurgical procedures and survived for different times after which they were slaughtered and their brains explanted and sent for macroscopic and microscopic investigation by the Pathological Anatomy Service. As a whole, Glubran2 was well tolerated in vivo and did not cause major damage in direct contact with brain tissue.

Multidisciplinary management of multiple spinal dural arteriovenous fistulae

Multiple SDAVFs are quite rare. We present two cases with double synchronous shunts and both were treated during one-stage interventional or surgical procedure. Unique images of the multiple SDAVFs as a PMAVF-like fistula were obtained. These interesting findings suggest the presence of multiple fistulas must be considered in patients being evaluated for SDAVF. A multidisciplinary approach to the management of multiple SDAVFs should depend on the anatomic location and angioarchitecture.

A Little Talk on Adamkiewicz's Artery. Some Practical Considerations on the Pre-Operative Identification of this Artery Starting from a Single Team Experience in Pre-Surgical Selective Embolization of Vascularized Spinal Lesions

The major radicular artery eponymically named "Adamkiewicz's artery" (AKA) is an important vessel supplying the spinal cord, especially the lumbar enlargement. This report emphasizes the importance of anatomical knowledge of this artery and highlights the concept of the potential risk of neurological complications during different procedures: spine orthopedic/neurosurgery, aortic repair (vascular surgery) and endovascular selective embolizations performed by interventional neuro/radiologists. Anatomical considerations are made on the spinal cord arterial circulation with a special focus on the AKA. Our review of the literature considered this anatomical element essential to compare the potential risk of spinal cord ischemic damage during orthopedic/neurosurgical spine procedures, aortic vascular surgery repair procedures and endovascular selective arterial embolizations. Evaluation of the endovascular selective arterial spine embolization risk was based on our series of 410 embolization procedures. Spinal cord infarction and transient or permanent paraplegia may result from inadvertent interruption of the AKA. The presence of intersegmental collaterals may decrease the risk of spinal cord ischemia: this is an important element to bear in mind that may help in spine surgery or aortic repair procedures performed by vascular surgeons. Nevertheless, during aortic repair (open surgery or stent-graft procedures) interruption of bilateral segmental arteries at multiple consecutive levels including that of the AKA may occur thereby increasing the ischemic spinal cord risk, annulling the benefit of intersegmental collaterals. Accidental embolizations of the AKA during endovascular spine procedures (i.e. selective arterial embolizations) performed by interventional neuro/radiologists will cause an almost certain spinal cord infarction due to the consequent embolizations of the anterior spinal artery (ASA).

Use of Glubran 2 acrylic glue in interventional neuroradiology

INTRODUCTION

Glubran 2 is a cyanoacrylate-based synthetic glue modified by the addition of a monomer synthesized by the manufacturer. With this material it is possible to obtain the stability of endovascular embolization that is needed to treat tumours and vascular disease.

MATERIAL AND METHODS

We report our 3-year experience of the use of Glubran for treating extracerebral tumours, spinal tumours, spinal arteriovenous malformations, and brain and spine dural fistulae. Glubran 2 was diluted with Lipiodol and injected in a continuous column with the flow rate monitored by seriography. The injection was stopped when retrograde flow was displayed in the afferent vessel.

RESULTS

There were no periprocedural or subsequent clinical complications and the glue resulted in successful selective permanent occlusion with intralesional penetration similar to the angiographic features of microcatheterization.

CONCLUSIONS

The embolization procedure was technically straightforward and relatively safe. However, Glubran 2 can be difficult to use and the procedure does carry major risks for patients. Glue injection requires in-depth study of the lesion, its circulation and the collateral circulation to avoid severe complications due to inappropriate use.