Preoperative Arterial Embolization Research Articles

Pilot Trial on Ischemic Conditioning of the Gastric Conduit in Esophageal Cancer: Feasibility and Impact on Anastomotic Leakage (TIGOAL-I)

Objective: To evaluate the feasibility, safety, and effectiveness of gastric conditioning using preoperative arterial embolization (PAE) before McKeown esophagectomy at a tertiary university hospital. Background: Cervical anastomotic leakage (AL) is a common complication of esophagectomy. Limited clinical evidence suggests that gastric conditioning mitigates this risk. Methods: This pilot randomized clinical trial was conducted between April 2016 and October 2021 at a single-center tertiary hospital. Eligible patients with resectable malignant esophageal tumors, suitable for cervical esophagogastrostomy, were randomized into 2 groups: one receiving PAE and the other standard treatment. The primary endpoints were PAE-related complications and incidence of cervical AL. Results: The study enrolled 40 eligible patients. PAE-related morbidity was 10%, with no Clavien-Dindo grade III complications. Cervical AL rates were similar between the groups (35% vs 25%, P = 0.49), even when conduit necrosis was included (35% vs 35%, P = 1). However, AL severity, including conduit necrosis, was higher in the control group according to the Clavien-Dindo ≥IIIb (5% vs 30%, P = 0.029) and Comprehensive Complication Index (20.9 vs 33.7, P = 0.01). No significant differences were found in other postoperative complications, such as pneumonia or postoperative mortality. Conclusions: PAE is a feasible and safe method for gastric conditioning before McKeown minimally invasive esophagectomy and shows promise for preventing severe AL. However, further studies are required to confirm its efficacy.

Preoperative Embolization of Vertebral Metastasis: Comprehensive Review of the Literature.

The aim of this review is to determine the safety and efficacy of pre-operative spinal metastases embolization procedures. Two reviewers independently conducted the literature search (on MEDLINE databases), including in the review of all the studies that used pre-operative TAE to treat spinal metastases. Twelve articles on pre-operative spinal metastases embolization were selected. Most of the studies demonstrated the low complication rate of pre-operative embolization. The most important study strength is that there are very few reviews in the literature with the setting on pre-operative vertebral metastases embolization. A limitation of the review is that the studies included were predominately retrospective case-control studies, increasing the risk of bias in the primary data. Plus, divergent surgical and embolization procedures were performed in the studies, causing a potential risk of bias in the pooled results. We can conclude that preoperative arterial embolization of vertebral metastases is a safe, well-tolerated technique that reduces surgical blood loss and facilitates surgical tumor resection.

SP2.5 Modified Appleby Procedure in the Treatment of Pancreatic Neoplasms

Abstract Aims This work aims to review the state of the art regarding the patients who may benefit from resection using the modified Appleby procedure, the pre- and post-operative procedures to increase survival, and the postoperative outcomes. Methods Research was conducted within the PubMed and Embase databases from July 2022 to January 2023, including single or multicenter articles relative to the modified Appleby procedure but comprising a multimodal approach to pancreatic neoplasms and not only the surgical technique, and papers concerning patients over the age of 18 years. Results Out of the 373 articles identified and after extracting duplicates, 267 records were accessed for a title and abstract screening. Afterward, by applying the inclusion and exclusion criteria to the remaining articles and conducting a further extensive reading of the remaining articles, 53 papers were included in this review. Secondary terms relevant to this topic were also used, allowing detection of additional research, thus totalizing the 57 publications included. Conclusion When applied to borderline resectable and locally advanced pancreatic cancer, the efficacy of the modified Appleby procedure alone is limited, but the combination with neoadjuvant chemotherapy offers the greatest chance of achieving an R0 resection. Many surgical technical options are available, with or without preoperative artery embolization, but the best results published to date were observed when employing robotic surgery with a retroperitoneal-first approach. However, the indication for performing this surgery and all its perioperative components are still a matter of debate.

Minimizing blood loss with direct percutaneous polymethylmethacrylate embolization before corpectomy for vascular spinal tumors.

Standard surgical treatment for vascular spinal tumors, including renal cell carcinomas and hemangiomas, may result in significant blood loss despite preoperative arterial tumor embolization. This is a retrospective review of 12 patients who underwent direct percutaneous polymethylmethacrylate embolization (DPPE) with or without feeding artery embolization before partial or complete corpectomy for the resection of vascular spinal tumors (2013-2018). Estimated blood loss (EBL) was compared to the blood loss reported in the literature and to patients receiving standard arterial embolization before surgery. The mean EBL for 12 patients was 1030 mL; three of 12 patients required blood transfusions. For the single level corpectomies, the EBL ranged from 100 mL to 3900 mL (mean 640 mL). This mean blood loss was not increased in patients receiving only DPPE preoperatively versus those patients receiving preoperative arterial embolization in addition to DPPE (1005 vs. 1416 mL); in fact, the EBL was significantly reduced for those undergoing DPPE alone. In this initial study, nine patients treated with DPPE embolization alone before spinal tumor resection demonstrated reduction of intraoperative blood loss compared to three patients having arterial embolization with DDPE.

Insights from managing clinical issues in distal pancreatectomy with en bloc coeliac axis resection: experiences from 626 patients.

Distal pancreatectomy with en bloc coeliac axis resection (DP-CAR) for pancreatic body cancer has been reported increasingly. However, its large-scale outcomes remain undocumented. This study aimed to evaluate DP-CAR volume and mortality, preoperative arterial embolization for ischaemic gastropathy, the oncological benefit for resectable tumours close to the bifurcation of the splenic artery and coeliac artery using propensity score matching, and prognostic factors in DP-CAR. In a multi-institutional analysis, 626 DP-CARs were analysed retrospectively and compared with 1325 distal pancreatectomies undertaken in the same interval. Ninety-day mortality was observed in 7 of 21 high-volume centres (1 or more DP-CARs per year) and 1 of 41 low-volume centres (OR 20.00, 95 per cent c.i. 2.26 to 177.26). The incidence of ischaemic gastropathy was 19.2 per cent in the embolization group and 7.9 per cent in the no-embolization group (OR 2.77, 1.48 to 5.19). Propensity score matching analysis showed that median overall survival was 33.5 (95 per cent c.i. 27.4 to 42.0) months in the DP-CAR and 37.9 (32.8 to 53.3) months in the DP group. Multivariable analysis identified age at least 67 years (HR 1.40, 95 per cent c.i. 1.12 to 1.75), preoperative tumour size 30 mm or more (HR 1.42, 1.12 to 1.80), and preoperative carbohydrate antigen 19-9 level over 37 units/ml (HR 1.43, 1.11 to 1.83) as adverse prognostic factors. DP-CAR can be performed safely in centres for general pancreatic surgery regardless of DP-CAR volume, and preoperative embolization may not be required. This procedure has no oncological advantage for resectable tumour close to the bifurcation of the splenic artery, and should be performed after appropriate patient selection.

Unexpected malignancy: resection of a large thoracic solitary fibrous tumour of the pleura with preoperative arterial emolisation.

Unexpected malignancy: resection of a large thoracic solitary fibrous tumour of the pleura with preoperative arterial emolisation.

Preoperative Arterial Embolization of Musculoskeletal Tumors: A Tertiary Center Experience.

The purpose of this study was to report the effectiveness of preoperative transcatheter arterial embolization (TAE) of musculoskeletal tumors in terms of blood loss and functional outcomes. Patients who underwent preoperative TAE of hypervascular musculoskeletal tumors between January 2018 and December 2021 were retrospectively included. The patients' characteristics, TAE procedure details, degree of post-TAE devascularization, surgical outcomes in terms of red blood cell transfusion and functional results were collected. The degree of devascularization was compared between patients who had peri-operative transfusion and those who did not. Thirty-one patients were included. The 31 TAE procedures led to complete (58%) or near-complete (42%) tumor devascularization. Twenty-two patients (71%) had no blood transfusion during surgery. Nine patients (29%) had a blood transfusion, with a median number of red blood cell packs of three (q1, 2; q3, 4; range: 1-4). Eight patients (27%) had complete improvement of the initial musculoskeletal symptoms at the end of the follow-up, 15 (50%) had partially satisfying improvement, 4 (13%) had partially unsatisfying improvement and 3 (10%) had no improvement. Our study suggests that preoperative TAE of hypervascular musculoskeletal tumors allowed for bloodless surgery in 71% of patients and minimal transfusion needs for the remaining 29%.

Retrospective, multicenter study of surgical treatment for carotid body tumors with or without preoperative embolization.

Carotid body tumor (CBT) is the most common head and neck paraganglioma. Whether preoperative embolization benefits CBT patients who will receive surgical resection is still controversial. In this multi-center retrospective study, we collected data from patients with CBT who received surgical treatment without (group A) or with preoperative embolization (group B) from 2011 to 2019. The primary outcome was the rate of death or stroke after 3 years of follow-up. The secondary outcomes of the study were length of operation (LOO), intraoperative blood loss (IBL), length of stay (LOS), rate of recurrence, and rate of cranial nerve (CN) injuries. Descriptive statistics were used to analyze the demographics, clinical characteristics, complications, and follow-up results of the patients. Between January 2011 and October 2019, 261 consecutive patients (107 male and 154 female) entered analysis. After 3 years of follow-up, no patient died in both groups. Only three patients with stroke were detected: 2/226 (0.9%) in group A vs. 1/35 (2.9%) in group B (p = .308). The LOO in group A was 132.6 ± 64.6min compared with 152.9 ± 40.4min in group B (p = .072). IBL in group A was 375.4 ± 497.8ml compared with 448.0 ± 270.8ml in group B (p = .400). LOS in group A was 8.3 ± 2.0 days compared with 7.4 ± 1.7 days in group B (p = .016). Seventy-two CN injuries were detected: 65/226 (28.8%) in group A vs. 7/35 (20.0%) in group B (p = .281). There were 65 temporary CN injuries (59 in group A vs. 6 in group B) (p = .254) and seven permanent CN injuries (6 in group A vs. 1 in group B) (p = .945). Three most frequently injured cranial nerves were the pharyngeal branch and superior laryngeal nerve (12.3%), recurrent laryngeal nerve (7.7%) and vagus nerve (7.3%). There was insufficient evidence to support the efficacy of preoperative embolization. CBT resection alone had a similar rate of stoke, recurrence, and CN injuries when compared with CBT resection with preoperative arterial embolization. Meanwhile, CBT resection alone did not increase LOO and IBL.

Neoadjuvant Arterial Embolization of Spine Metastases Associated With Improved Local Control in Patients Receiving Surgical Decompression and Stereotactic Body Radiotherapy.

Spine metastases often cause significant pain, instability, and/or neurological morbidity. Local control (LC) of spine metastases has been augmented with advances in systemic therapies, radiation, and surgical technique. Prior reports suggest an association between preoperative arterial embolization and improved LC and palliative pain control. To further elucidate the role of neoadjuvant embolization on LC of spine metastases and the potential for improved pain control in patients receiving surgery and stereotactic body radiotherapy (SBRT). A retrospective single-center review between 2012 and 2020 identified 117 patients with spinal metastases from various solid tumor malignancies managed with surgery and adjuvant SBRT with or without preoperative spinal arterial embolization. Demographic information, radiographic studies, treatment characteristics, Karnofsky Performance Score, Defensive Veterans Pain Rating Scale, and mean daily doses of analgesic medications were reviewed. LC was assessed using magnetic resonance imaging obtained at a median 3-month interval and defined as progression at the surgically treated vertebral level. Of 117 patients, 47 (40.2%) underwent preoperative embolization, followed by surgery and SBRT and 70 (59.8%) underwent surgery and SBRT alone. Within the embolization cohort, the median LC was 14.2 months compared with 6.3 months among the nonembolization cohort (P = .0434). Receiver operating characteristic analysis suggests ≥82.5% embolization predicted significantly improved LC (area under the curve = 0.808; P < .0001). Defensive Veterans Pain Rating Scale mean and maximum scores significantly decreased immediately after embolization (P < .001). Preoperative embolization was associated with improved LC and pain control suggesting a novel role for its use. Additional prospective study is warranted.

ROLE OF PREOPERATIVE EMBOLIZATION IN BONE TUMORS- A case control study

Preoperative embolization of bone tumor is a minimally invasive angiographic intervention technique and effective adjuvant treatment option for bone tumors. In 1975, Feldman was the rst to use the pre-operative arterial embolization technique to downstage the vascularity of bone tumors, thus reducing blood loss during surgery. Surgery remains the mainstay treatment option for bone tumors. Embolization reduces tumor vascularity and hence decreases intraoperative blood loss and intraoperative blood transfusion. It enables more accurate delineation of tissue planes during surgery, resulting in complete removal of the bone tumor. The most frequent bone tumors that typically need preoperative embolization are those difcult to operate on because of their huge size, high degree of vascularity, proximity to critical tissues, or difcult surgical access. PVA particles are regarded as a workhorse in preoperative transarterial embolization and thus used commonly as an embolizing agent. It is safe procedure and therefore can be used as part of the multidisciplinary approach to the management highly vascular bone tumors.

Preoperative Arterial Embolization for Heterotopic Ossification of the Hip

PurposeTo investigate the efficacy and safety of preoperative arterial embolization for neurogenic heterotopic ossification (NHO) of the hip. Materials and MethodsThis single-center retrospective study reviewed outcomes in 16 consecutive patients who had surgical resection of NHO of the hip: 8 of whom underwent preoperative arterial embolization and 8 of whom did not. Both patient cohorts had similar baseline characteristics. A mean of 2.62 ± 1.9 arteries per patient, including the gluteal, lateral circumflex femoral, and deep circumflex iliac branches, were embolized using an n-butyl cyanoacrylate (NBCA)–ethiodized oil mixture. Data from both cohorts regarding intraoperative blood loss, volume of blood transfused, complications, and duration of hospitalization were compared. ResultsA mean of 2.6 ± 1.9 arteries were embolized with NBCA–ethiodized oil, mainly the gluteal arteries, lateral circumflex femoral artery, and deep circumflex iliac artery. In the embolization group, mean intraoperative blood loss was 875 mL ± 320, mean number of units of blood used was 0.5 ± 0.7, and mean number of days of hospitalization was 6.4 days ± 1.6. In the control group, mean intraoperative blood loss was 1,350 mL ± 120, mean number of units of blood used was 2 ± 1.1, and average number of days of hospitalization was 11.5 days ± 1.4. The embolization group had a mean reduction in blood loss of 40.7% (P = 0.035), reduction in units of blood administered of 75% (P = 0.021), and reduction in days of hospitalization of 44.7% (P = 0.014). No procedural complications were recorded. ConclusionsPreoperative arterial embolization is effective and safe in reducing intraoperative blood loss, number of hospitalization days, and need for blood transfusions in surgical resection of NHO of the hip.

Multiple Strategies to Avoid Life-threatening Blood Loss During Intralesional Resection of a Giant Plexiform Neurofibroma: A Case Report

Giant plexiform neurofibroma (PNs) are benign peripheral nerve sheath tumors known to contain multiple fascicles of nerve and numerous friable vascular components. Most consult due to significant disfigurement and functional deficit. Though surgery is the current standard of therapy, there is high reservation in pushing through with resection in most cases. The reservation stems from the recognized difficulty in controlling intraoperative life-threatening hemorrhage. A 25-year-old female came in our institution due to multiple debilitating giant PNs on her scalp, back, neck, shoulder, and chest. She opted for debulking surgery despite possible complications and recurrence. Multiple modalities used to prevent massive bleeding in this case included preoperative arterial embolization, energy sealing device, cutting linear stapler, and interlocking retention sutures. The aim of this case report was to discuss the utility of each of these techniques, the advantages and disadvantages of each approach based on our experience. Key words: Neurofibromatosis type-1, plexiform neurofibroma, hemorrhage, neurofibroma resection, preoperative arterial embolization

Preoperative liver arterial conditioning in patients scheduled for a mayo clinic class IA distal pancreatectomy: Embolization or ligation?

Patients who undergo intraoperative ligation of the common hepatic artery in Mayo Clinic class I distal pancreatectomy with en bloc celiac axis resection (DP-CAR) might be exposed to liver ischemia. To avoid serious adverse postoperative outcomes related to arterial reconstruction, preoperative liver arterial conditioning by embolization or ligation is used. Here, we report our experience of preoperative liver conditioning by arterial embolization (AE) or laparoscopic ligation (LL) of the common hepatic artery before Class Ia DP-CAR. From 2014 to 2021, 15 patients were scheduled for a Class Ia DP-CAR after neoadjuvant FOLFIRINOX treatment. Six patients underwent AE, while nine underwent LL. Two procedural complications occurred in the AE group: one patient had an incomplete dissection of the proper hepatic artery, and one patient had distal migration of coils in the right branch of the hepatic artery. None of these complications prevented surgery. The median delay between liver conditioning and DP-CAR was 19 days; this delay decreased to 5 days in the last five patients. Arterial reconstruction was not performed. The severe morbidity and 90-days mortality rates were 26.7% and 13.3%, respectively. No patient developed postoperative liver insufficiency. No differences were noted between the groups in terms of the postoperative course. Preoperative AE and LL were comparable in terms of avoiding arterial reconstruction and postoperative liver insufficiency in patients scheduled for class Ia DP-CAR. However, the possible serious complications that may arise during AE led us to prefer the LL technique.

Preoperative arterial embolization and wound complications after resection of malignant bone tumor in the pelvis: a nationwide database study.

Massive intraoperative blood loss is common in pelvic malignant bone tumor surgery, and preoperative arterial embolization may be used in selected cases. Preoperative arterial embolization reportedly increases wound complications in pelvic fracture surgery, but little evidence is available regarding pelvic bone tumor surgery. Using a Japanese nationwide database (Diagnosis Procedure Combination database), we searched for patients who underwent pelvic malignant bone tumor surgery between July 2010 and March 2018. The primary endpoint was wound complications, defined as any wound requiring re-operation, negative pressure wound therapy or both. Univariate analyses (the chi-squared test for categorical variables, the unpaired t-test for continuous variables) and multivariate logistic regression analyses were performed to examine the association between preoperative arterial embolization and wound complications. Among the 266 eligible patients, 43 (16%, 43/266) underwent embolization and 69 (26%, 69/266) developed wound complications. In the univariate analyses, preoperative arterial embolization (P<0.001), duration of anesthesia (P<0.001), the volume of blood transfusion (P<0.001) and duration of indwelling drain tube (P<0.001) were associated with wound complications. In the multivariate logistic regression analysis, preoperative arterial embolization was significantly associated with wound complications (odds ratio, 3.92; 95% confidence interval, 1.80-8.56; P=0.001). Preoperative arterial embolization may be associated with increased wound complications after pelvic malignant tumor surgery.

Long-term outcomes of ruptured hepatocellular carcinoma: An international multicentric propensity score-matched study

Abstract Objective Long-term outcomes of patients with ruptured hepatocellular carcinoma (rHCC) remain scant. This study aimed to assess disease-free survival (DFS) and overall survival (OS) after surgical resection of rHCC compared to non-ruptured HCC (nrHCC). Methods Patients with rHCC and nrHCC were collected from 8 centers in Europe, Asia, and North America. Resected rHCC patients were matched 1:1 to patients undergoing surgery for nrHCC using propensity score and nearest-neighbor method (matching criteria: age, tumor size, cirrhosis, Child-Pugh score, Barcelona Clinic Liver Cancer stage, resection status, grade, and microvascular invasion). Survival rates were calculated using Kaplan-Meier method. Results A total of 2033 patients were included: 226 rHCC patients (172 operated: 68 with upfront surgery and 104 after embolization) and 1807 nrHCC patients. Median DFS and OS of rHCC patients (all treatments confounded) were 10 months (95% CI 7–13) and 22 months (95% CI 13–31). Prognostic factors for worse OS among rHCC patients were absence of preoperative arterial embolization (HR 2.3, 95% CI 1.2–4.6, p=0.016), cirrhosis Child B/C (HR 2.4, 95% CI 1.1–5.4, p=0.040), and R1/R2 margins (HR 2, 95% CI 1–5, p=0.049). Survivals were similar between Western and Eastern rHCC patients. After propensity score matching, 106 rHCC patients and 106 nrHCC patients displayed similar characteristics. Patients with rHCC had shorter median DFS (12 months, 95% CI 7–17 vs. 22 months, 95% CI 12–32, p=0.011), but similar median OS compared to nrHCC patients (43 months, 95% CI 21–65 vs. 63 months, 95% CI 21–105, p=0.060). Conclusion In this large dataset including Eastern and Western patients, rHCC was associated with shorter DFS compared to nrHCC, while OS was similar.

Guiding Value of Circulating Tumor Cells for Preoperative Transcatheter Arterial Embolization in Solitary Large Hepatocellular Carcinoma: A Single-Center Retrospective Clinical Study.

BackgroundLarge hepatocellular carcinoma (LHCC) is highly malignant and prone to recurrence, leading to a poor long-term prognosis for patients. There is an urgent need for measures to intervene in postoperative recurrence. Preoperative Transcatheter Arterial Embolization (TACE) is an effective treatment. However, there is a lack of reliable preoperative indicators to guide the application of preoperative TACE. We, therefore, investigated whether the preoperative status of circulating tumor cells (CTCs) could be used to guide preoperative TACE for HCC treatment.MethodsThis study recruited 361 HCC patients and compared recurrence-free survival (RFS) and overall survival (OS) in patients treated with TACE prior to surgery and those not treated with TACE. Patients were divided into CTC-positive group and CTC-negative group according to CTC status, and the effect of preoperative TACE on RFS and OS was compared in each subgroup.ResultsIn CTC-positive patients, preoperative TACE reduces early recurrence and improves long-term survival. However, HCC patients did not benefit from preoperative TACE for the overall population and CTC-negative patients.ConclusionsPreoperative CTC testing is a reliable indicator of whether HCC patients received TACE preoperatively. CTC positivity was associated with early tumor recurrence, and preoperative TACE could reduce early recurrence and long-term prognosis in CTC-positive patients.

New adjustable modular hemipelvic prosthesis replacement with 3D-print osteotomy guide plate used in periacetabular malignant tumors: a retrospective case series

BackgroundPeriacetabular malignant tumor seriously endangers the life and health of patients. Hemipelvic replacement provides a good method for patients who want complete resection of the tumor while retaining or restoring the function of the affected limb.ObjectiveTo investigate the performance and clinical application of the new adjustable modular hemipelvic prosthesis and to compare the effects of three kinds of hemipelvic prosthesis.MethodsIn this study, 23 patients, with an average age of 44.6 years (21–75 years), were collected, who received hemipelvic replacement with new adjustable, modular, and screw-rod system hemipelvic prosthesis. Preoperative preparation was conducted on them, and operative complications were recorded. Postoperative functional follow-up was performed regularly.ResultsThe average operation time was 319 min (170–480 min), and the average blood loss was 2813 ml (1000 mL-8000 ml). The incidence of complications was 47.8%, and type A (wound-related complications) had the highest incidence (34.8%). Postoperative dislocation occurred in 3 cases (13.0%), and no dislocation occurred in the new adjustable modular hemipelvic prosthesis group. The average MSTS score of the patients was 18.6 (10–23), and the average Harris score was 73.7 (53–87).ConclusionsThe new adjustable modular hemipelvic prosthesis has the feasibility of reconstruction and good functional outcome, making it ideal for periacetabular tumors. Furthermore, preoperative tumor-feeding artery embolization and abdominal aortic balloon implantation may be an effective choice to reduce intraoperative blood loss and facilitate the operation of tumor resection.

Application of osteoinductive calcium phosphate ceramics in giant cell tumor of the sacrum: report of six cases

This study aimed at evaluating the possibility and effectiveness of osteoinductive bioceramics to fill the tumor cavity following the curettage of sacral giant cell tumor (GCT). Six patients (four females and two males, 25–45 years old) underwent nerve-sparing surgery, in which the tumor was treated by denosumab, preoperative arterial embolization and extensive curettage. The remaining cavity was filled with commercial osteoinductive calcium phosphate (CaP) bioceramics, whose excellent osteoinductivity was confirmed by intramuscular implantation in beagle canine. All patients were followed by computed tomography (CT) scans postoperatively. According to the modified Neer criterion, five cases obtained Type I healing status, and one case had Type II. At the latest follow-up, no graft-related complications and local recurrence were found. The CT scan indicated a median time of healing initiation of 3 months postoperatively, and the median time for relatively complete healing was 12 months. The excellent bone regenerative ability of the ceramics was also confirmed by increased CT attenuation value, blurred boundary and cortical rim rebuilding. In conclusion, osteoinductive CaP bioceramics could be an ideal biomaterial to treat the large remaining cavity following extensive curettage of sacral GCT. However, further investigation with more cases and longer follow-up was required to confirm the final clinical effect.

Preoperative Arterial Coil Embolization for Temporomandibular Joint (TMJ) Surgery in Children with TMJ Ankylosis.

Temporomandibular joint (TMJ) ankylosis in children can alter facial development and affect oral hygiene and function. Surgical release of the ankylosis is the mainstay of treatment. The authors hypothesize that preoperative arterial coil embolization is safe and effective in preventing major blood loss during TMJ surgery (loss prompting blood transfusion or hemodynamic instability requiring vasoactive medication administration) in children with TMJ ankylosis. Patients < 16 years who were diagnosed with TMJ ankylosis (<15 maximal interincisal opening) and had embolization before surgery in the last 5 years were included. Out of 9 initial search results, 3 patients were excluded (age > 16). Information gathered were patient demographics, diagnostic imaging, procedural details, complications, and clinical outcomes. Six patients, mean age 11.14 years (range 7-15 years) year and a mean weight of 40.8 ± 19 kg were included. Underlying etiologies for TMJ ankylosis: Pierre Robin Syndrome (n = 2), juvenile rheumatoid arthritis (n = 1), Goldenhar's syndrome (n = 1), trauma (n = 1), and micrognathia (n = 1). Neck computed tomography angiogram before embolization demonstrated an intimate approximation between the internal maxillary artery (IMAX) and/or external carotid artery and ankylotic mass in all patients. Eight successful embolizations were performed without procedural complication. In 1 patient with angiographic evidence of surgical internal maxillary artery ligation, embolization was performed via collaterals. Surgery was performed within 48 hours of embolization. Airway access during surgery was via nasal intubation (n = 4), oral intubation (n = 3). The estimated blood loss (EBL) during surgery was 78.33 ± 47.08 ml. Three patients had subsequent TMJ surgery with a mean estimated blood loss of 73.33 ± 46.18 ml. After a mean follow-up of 17 ± 15 months, patients showed a 13.8mm mean increment of maximal interincisal opening with 95% CI (5.74-21.9), P < 0.007.

833 Potential Palliative Role for Neoadjuvant Arterial Embolization in Patients with Spine Metastases

INTRODUCTION: Approximately two-thirds of all cancer patients will develop bone metastasis, and the spine is the most common site.1 Spine metastases may lead to significant pain, instability, and/or neurological morbidity. A high rate of local control can be achieved with local therapies such as radiation and surgery, but persistent pain is described among some patients. Prior clinical research demonstrated that arterial embolization without surgery may improve pain associated with spine metastases.2 This study aimed to determine the effects of embolization on pain in patients undergoing surgical decompression and stabilization. METHODS: A retrospective single-center review between 2012 and 2020 identified 117 patients receiving adjuvant SRS or SBRT following surgical intervention for spine metastases. The study group included various primary tumor types and patients treated with laminectomy and/or varying degrees of vertebrectomy. Data analyzed included demographic information, embolization and surgical details, KPS, defensive veterans pain rating scale (DVPRS), dose of radiotherapy, and daily doses of analgesic medications. RESULTS: Of 117 patients, 47 (40.2%) underwent preoperative embolization. Forty-nine (70%) and 24 (51.1%) patients underwent laminectomy/partial vertebrectomy in the non-embolization and embolization cohorts, respectively. Demographics were similar between groups at baseline. DVPRS scores did not differ by primary tumor histopathology (p = 0.63). DVPRS daily average and maximum rest scores decreased from 5.6 to 3.7, p &lt; 0.001, and 5.7 to 3.8, p &lt; 0.001, respectively following embolization. Throughout postoperative days 1-14, pain scores and daily doses of analgesic medications were largely similar between cohorts. CONCLUSIONS: Preoperative arterial embolization decreases pain scores immediately after the procedure, consistent with prior literature. This palliative effect largely disappears in the postoperative period, likely due to surgical pain. Future prospective studies identifying long-term palliative effects of embolization for spine metastasis are needed.