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Efficacy of preoperative embolization for metastatic spinal tumor surgery using angiographic vascularity assessment

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Preoperative embolization (PE) for metastatic spinal tumors is a method of minimizing intraoperative blood loss during aggressive surgery. This study specified angiographic standards and investigated the influence of these and other factors on blood loss in patients with spinal metastases and various pathologies.

Methods

The cohort comprised 126 consecutive patients receiving PE from 2015 to 2021. Their clinical, surgical, and angiographic characteristics were reviewed. Standard angiographic grading was used for vascularity assessment. Degree of embolization was divided into complete (≥ 90%), near complete (67 to < 90%), and partial (< 67%). Logistic regression analysis was used to investigate factors predictive of massive blood loss (> 2500 mL). A proportional odds model was used to assess factors predictive of the degree of embolization.

Results

Mean intraoperative blood loss was 1676 mL. Among the patients, 62 had hypervascular tumors and 64 had nonhypervascular tumors, according to the angiographic classification. Intraoperative blood loss differed significantly with embolization degree, both overall (p < 0.001) and in the hypervascular and nonhypervascular groups (p = 0.01 and 0.03). Angiographic hypervascularity, spinal metastasis invasiveness index, and embolization degree were significant predictors of massive blood loss in univariate analysis, but only embolization degree was significant in multivariate analysis. Only the presence of the radiculomedullary artery at the target level was significant in both the univariate and multivariate analyses for embolization degree.

Conclusions

In addition to pathological classification, angiographic vascularity assessment is valuable. Although complete embolization is a reasonable goal, it is challenging to achieve in cases of visible radiculomedullary artery.

Key Points

• Angiography has a supplementary role in vascularity assessment for spinal metastatic surgery.

• Better embolization degree is associated with less intraoperative blood loss in both angiographic hypervascular and nonhypervascular groups.

• Presence of radiculomedullary artery in the target level causes worse embolization outcome.

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Abbreviations

aOR:

Adjusted odds ratio

CI:

Confidence interval

CTA:

Computed tomography angiography

HCC:

Hepatocellular carcinoma

MRI:

Magnetic resonance imaging

NBCA:

n-Butyl-2-cyanoacrylate

OR:

Odds ratio

PE:

Preoperative embolization

RCC:

Renal cell carcinoma

SINS:

Spinal instability neoplastic score

SMII:

Spinal metastasis invasiveness index

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Acknowledgements

The authors acknowledge the statistical assistance provided by the Center of Statistical Consultation and Research of the Department of Medical Research, National Taiwan University Hospital.

Funding

This study was supported by grants from the Ministry of Science and Technology, Taiwan (MOST 109-2314-B-002-097-) and from National Taiwan University Hospital, Taipei, Taiwan; Contract grant number: A1 project no. NTUH 111-A162.

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Authors and Affiliations

  1. Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10055, Taiwan

    Yu-Cheng Huang, Chung-Wei Lee & Yen-Heng Lin

  2. Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan

    Yu-Cheng Huang, Fon-Yih Tsuang & Yen-Heng Lin

  3. Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan

    Fon-Yih Tsuang

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  1. Yu-Cheng Huang
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Correspondence to Yen-Heng Lin.

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Guarantor

The scientific guarantor of this publication is Dr. Yen-Heng Lin.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

The statistical works had been reviewed by a biostatistician and a statistical analyst in the Center of Statistical Consultation and Research of the Department of Medical Research, National Taiwan University Hospital.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

The study was approved by the research ethics committee of the National Taiwan University Hospital. Approval number: 201810005RIND

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• performed at one institution

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Huang, YC., Tsuang, FY., Lee, CW. et al. Efficacy of preoperative embolization for metastatic spinal tumor surgery using angiographic vascularity assessment. Eur Radiol 33, 2638–2646 (2023). https://doi.org/10.1007/s00330-022-09276-3

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  • DOI: https://doi.org/10.1007/s00330-022-09276-3

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