Preoperative Embolization Research Articles

Preoperative embolisation of renal cell carcinoma metastases to the spine - evaluation of procedural and clinical outcome.

Renal cell carcinoma (RCC) is the fourth most common metastatic tumour of the spine. RCC metastases are highly vascular and might cause life-threatening intraoperative bleeding. That is why preoperative embolisation is performed to reduce intraoperative blood loss. The aim of this study was to evaluate the procedural and clinical outcomes of preoperative embolisation of RCC metastases to the vertebral column. In this single-centre retrospective study, data of 59 consecutive patients undergoing endovascular treatment prior to surgical resection were collected and evaluated. In all cases superselective catheterisation and occlusion of feeding vessels was attempted and performed if deemed safe and possible. Completeness of embolisation, procedural details, and the complication rate were evaluated. Surgical procedures were carried out within 48 hours after embolisation. The surgical approach was dependent on the anatomical site and osseous destruction. Intraoperative blood loss was estimated. Fifty-nine patients with a mean age of 63 years were included. Complete embolisation was successful in 76% (45/59) and partial in 15% (9/59). Microspheres were the most commonly used embolic material. In 5 cases (8%) safe occlusion was not possible due to the radiculomedullary artery originating from the same pedicle as the tumour. Minor complications (vomiting, increased pain) occurred in 8 patients. Paraplegia (one transient and one permanent) was noted in 2 cases. Estimated intraoperative blood loss was 830 ± 410 ml. The results of our study show that preoperative embolisation is a feasible and effective method with a relatively high rate of occlusion and low complication rate.

Differences and Advantages of Particles versus Liquid Material for Preoperative Intracranial Tumor Embolization: A Retrospective Multicenter Study.

The superiority and usefulness of liquid material over particles for embolization have been a topic of debate due to differences in materials and techniques. This study aimed to identify the complications and outcomes associated with both embolization materials. This retrospective multicenter cohort study included 93 patients from an endovascular treatment registry, treated from January 1, 2018 to May 31, 2022. It included patients who underwent preoperative embolization for meningioma, solitary fibrous tumor/hemangiopericytoma, and hemangioblastoma. Data for patient characteristics, procedural factors, complications, and outcomes were collected from medical records. A tortuous access route was the only factor independently associated with complications (p = 0.020). Although liquid material was more frequently used for embolization in relatively high-risk conditions, complication rates did not differ significantly between the groups (p = 0.999). In the liquid material group, the tip of the microcatheter could be guided closer to the tumor (p <0.001) using a distal access catheter and flow-guide microcatheters. The subgroup middle meningeal artery embolization had less operative bleeding in the liquid material group (p <0.001), whereas the particles group exhibited less intraoperative blood loss than the liquid material group (p = 0.006). The vascular tortuosity of the access route was only associated with complications in preoperative tumor embolization. Liquid material and particles showed no difference in complication rates. The use of particles in embolization may reduce intraoperative bleeding, but not in all cases can it be used safely. Therefore, a thorough understanding of the characteristics of both approaches and their relative advantages in clinical practice is essential to opt for the appropriate material according to the case.

Safety of preoperative branch embolization in patients undergoing evar.

The purpose of this systematic review is to evaluate the safety of pre-endovascular abdominal aortic aneurysm repair (EVAR) embolization of aortic side branches - the inferior mesenteric artery and lumbar arteries. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. A search of MEDLINE and DIMENSION databases identified 9 studies published from 2011 to 2021 that satisfied the inclusion and exclusion criteria. These studies were analyzed to detect the incidence of embolization-related complications. A total of 482 patients underwent preoperative aortic side branch embolization, 30 (6.2%) of whom suffered some kind of minor complication. The only major complication observed was ischemic colitis in 4 (0.82%) patients, two (0.41%) of whom died after bowel resection surgery. Regarding these findings, aortic side branch embolization seems to be a safe procedure, with very low percentages of both minor and major complications.

Efficacy of Subtraction Computed Tomography Arteriography During Preoperative Embolization in Spinal Tumors.

This study aimed to evaluate the efficacy of subtraction computed tomography arteriography (s-CTA) during preoperative embolization in spinal tumors. The study analyzed 17 vertebrae in 13 patients who underwent preoperative embolization before spinal fixation surgery for malignant spinal tumors to decrease blood loss at our hospital from 2019 to 2021. Their ages ranged from 56 to 88 years (average, 73.5 years). Metastatic bone tumors were most common, including five cases originating as lung carcinomas and three as renal cancers. After digital subtraction angiography of selected tumor-feeding arteries and non-subtraction CTA (ns-CTA) were performed, s-CTA was conducted using data obtained from both procedures. A clarity score of the boundary between the normal bone and tumor was derived for each patient, which was then classified into four grades (good, 3 points; fair, 2 points; faint, 1 point; poor, 0 points) by two experienced radiologists, followed by a comparison between the s-CTA and ns-CTA groups using the Wilcoxon signed-rank test. Clarity scores were significantly higher in the s-CTA group than in the ns-CTA group (P < 0.001). The agreement of Cohen's coefficients between the two radiologists was κ = 0.724 in s-CTA scoring and κ = 0.622 in ns-CTA scoring, which were moderately matched. Seven arteries were not embolized due to insufficient tumor contrast enhancement and their poor relation to the surgical invasion zone. No complications were observed during or after embolization. S-CTA successfully distinguished between tumor and normal bone and may help avoid unnecessary embolization.

Embosphere Size Selection and Dilution Rate in Preoperative Tumor Embolization of the External Carotid Artery System Using a Small-diameter Catheter.

The widespread adoption of preoperative embolization in highly vascularized brain tumors often involves the frequent use of Embosphere (Merit Medical Systems, South Jordan, Utah, USA). Nevertheless, inconsistency in size selection and dilution rates across different institutions requires comprehensive examination. This study explored the appropriate size and dilution rate of Embosphere microspheres. To assess catheter occlusion and Embosphere breakage, various dilutions (4-, 10-, 20-, 30-, and 60-fold) of Embosphere 300-500 and 500-700 μm were injected into the catheter in vitro. Results indicated that 20-fold or higher dilutions of Embosphere 300-500 μm and 30-fold or higher dilutions of Embosphere 500-700 μm showed no occlusion of the Excelsior SL-10 microcatheter (Stryker, Fremont, CA, USA) or Embosphere breakage. For embolization, to reduce the risk of Excelsior SL-10 occlusion further, a 30-fold dilution of Embosphere 300-500 μm and a 60-fold dilution of Embosphere 500-700 μm were employed. For 195 blood vessels in 107 patients (84 with meningioma and 23 with schwannoma), embolization was carried out using a 30-fold dilution of Embosphere 300-500 μm when the provocative test was negative and a 60-fold dilution of Embosphere 500-700 μm when the test was positive or when there was a risk of migration into neurotrophic vessels. Contrast-enhanced magnetic resonance imaging after embolization revealed a reduced enhancement effect in 69.1% of cases. Embolization using a 30-fold dilution of Embosphere 300-500 μm and a 60-fold dilution of Embosphere 500-700 μm with an Excelsior SL-10 catheter is safe and satisfactory, which minimizes microcatheter occlusion.

Accidental Microcoil Migration into Right Atrium during Portal Vein Embolisation: A Case Report

With the advancement of technology in the field of medicine, minimally invasive vascular procedures are widely utilised for therapeutic effects. Embolisation is a minimally invasive approach to occlude a vessel for therapeutic benefit. However, these procedures are associated with a small percentage of complications, one of which is the migration of the embolising agent. Migration refers to the movement of the embolisation agent (mostly a coil) from the original placement site to an unwanted location. A 59-year-old male presented with complaints of abdominal pain lasting 2-3 months. A Contrast-enhanced Computed Tomography (CECT) scan of the abdomen revealed an ill-defined infiltrative lesion arising from the neck and body of the gallbladder. Curative surgery was planned in the form of an extended right hepatectomy; however, the Future Liver Remnant (FLR) calculated was not optimal (19%). The patient was therefore referred for preoperative Portal Vein Embolisation (PVE). During the procedure, there was an accidental microcoil migration to the right heart post-PVE, which was managed by minimally invasive techniques. The importance of multimodality imaging techniques used to identify the location and multidisciplinary approaches to aid management has also been highlighted.

Teleproctoring in therapeutic neurointervention: Experience from Iraq-Saudi Arabia collaboration.

Proctoring in neuroendovascular surgery is one of the potential solutions for the shortage of personnel and experience, particularly in unstable and limited-resource areas such as Iraq. The study was conducted at the Baghdad Neurovascular Center (BNC), the first Hybrid neurovascular institution in Iraq, where sequential online zoom-based meetings between the BNC team and the expert from the Kingdom of Saudi Arabia were used for teleproctoring for neurointerventional procedures. A total of 28 sessions were conducted, four sessions for each case. Seven cases with various intracranial vascular lesions were operated for neuroendovascular procedures from July/2021 to March/2022. The teleproctoring for each case included four sequential sessions: (1) preoperative planning, (2) device selection and preparation, (3) intraoperative live-stream proctoring, and (4) postoperative reflection and follow-up planning. The procedures include coiling for dural arteriovenous fistula; preoperative tumor embolization; preoperative, partial, and staged embolization for arteriovenous malformation; coiling for intracranial aneurysm; and attempted Giant aneurysm flow-diversion. Major complications were avoided through teleproctoring, and all patients had good outcomes. In addition, the teleproctoring provided an effective training experience to the local neuroendovascular team that is otherwise not feasible. Teleproctoring is an effective and feasible tool to improve patient outcomes and provide a training experience to the local neuroendovascular teams in resource-limited regions.

Surgical management of spinal metastases from primary thyroid carcinoma: Demographics, clinical characteristics, and treatment outcomes - A retrospective analysis.

Metastatic spinal tumors represent a rare but concerning complication of primary thyroid carcinoma. We identified demographics, metastatic features, outcomes, and treatment strategies for these tumors in our institutional cohort. We retrospectively reviewed patients surgically treated for spinal metastases of primary thyroid carcinoma. Demographics, tumor characteristics, and treatment modalities were collected. The functional outcomes were quantified using Nurik, Modified Rankin, and Karnofsky Scores. Twelve patients were identified who underwent 17 surgeries for resection of spinal metastases. The primary thyroid tumor pathologies included papillary (4/12), follicular (6/12), and Hurthle cell (2/12) subtypes. The average number of spinal metastases was 2.5. Of the primary tumor subtypes, follicular tumors averaged 2.8 metastases at the highest and Hurthle cell tumors averaged 2.0 spinal metastases at the lowest. Five patients (41.7%) underwent preoperative embolization for their spinal metastases. Seven patients (58.3%) received postoperative radiation. There was no significant difference in progression-free survival between patients receiving surgery with adjuvant radiation and surgery alone (P = 0.0773). Five patients (41.7%) experienced postoperative complications. Two patients (16.7%) succumbed to disease progression and two patients (16.7%) experienced tumor recurrence following resection. Postsurgical mean Nurik scores decreased 0.54 points, mean Modified Rankin scores decreased 0.48 points, and mean Karnofsky scores increased 4.8 points. Surgery presents as an important treatment modality in the management of spinal metastases from thyroid cancer. Further work is needed to understand the predictive factors for survival and outcomes following treatment.

Management of Cervical Spine Metastasis from Renal Cell Carcinoma: A Rare Case Report with an Overview

Introduction: Renal cell carcinoma (RCC) accounts for 2–3% of adult malignant tumors, often metastasizing to bones, especially the spine. Spinal metastasis has a poor prognosis, but solitary spinal tumors have better outcomes with targeted chemotherapy, radiotherapy, and newer surgical approaches. Due to RCC’s high vascularity and resistance to treatments, en bloc vertebrectomy with anterior and posterior fixation is the gold standard for solitary lesions. This case report discusses a young man with C-7 cervical vertebrae metastasis, causing right upper limb weakness and severe neck pain. Case Report: A 43-year-old male presented with 4 weeks of neck pain (visual analogue scale score 7) radiating to the right upper limb, with tingling and numbness. Examination showed C7 tenderness, decreased power (4/5) in C7 and C8, and 50% reduced sensation. MRI revealed a metastatic hyperintense lesion at C7 causing collapse, anterior and posterior cortex bulging, anterior thecal sac indentation, and left neural foramen narrowing. He underwent anterior cervical thoracic exploration (C6-T1) with partial sternotomy, tumor excision, C7 corpectomy, cord decompression, MESH cage insertion, and anterior cervical plate fixation, followed by posterior C5–C6 lateral mass and T1–T2 pedicle screw fixation. Neurological power in C7–C8 improved from 4/5 to 5/5, and sensation reduction improved from 50% preoperatively to 10% at 12 weeks. Conclusion: Advancements in primary disease treatment necessitate evolving strategies for cervicothoracic metastasis. Combining extensive anterior and posterior techniques is now standard, enhancing patient quality of life through effective support and stabilization. Early diagnosis and referral are essential for pain relief and preventing neurological deficits and cord compression. Total en bloc vertebrectomy, the gold standard for solitary spinal metastasis, should include pre-operative embolization to reduce intraoperative bleeding. Prognosis relies on timely diagnosis, histological grading, and a comprehensive approach incorporating both medical and surgical treatments. Keywords: Renal cell carcinoma, spinal metastasis, en bloc, vertebrectomy, cervical vertebrae metastasis, anterior and posterior fixation.

Benefits of preoperative embolization before resection of a giant convexity meningioma: a case report

Benefits of preoperative embolization before resection of a giant convexity meningioma: a case report

Pre- and Post-operative Parameters among Patients Undergoing Pre-operative Embolization of Meningioma: a Tertiary Referral Center Experience

Pre- and Post-operative Parameters among Patients Undergoing Pre-operative Embolization of Meningioma: a Tertiary Referral Center Experience

The importance of preoperative embolization in carotid body tumors

The importance of preoperative embolization in carotid body tumors

MASSIVE PRIMARY LEIOMYOSARCOMA ON CAVUM THORAX : A VERY RARE CASE

The cavum thorax primary leiomyosarcoma is extremely rare and unusual case. leiomyosarcoma as smooth muscle carcinoma could be comes from various part of body as primary site, but in the case of cavum thorax leiomyosarcoma its estimated only 1-4 of all soft tissue sarcoma. In this report we present a 69 years old woman came to the outpatient clinic with a big lump in the chest. This lump has been felt for 1 year and was a big and bizarre looking tumor, pain was felt in the right chest with intensity of 4-5 visual analog scale. Difficulty to breath and shortness of breath was not complained by the patient, nausea and vomiting was not complained. The patient has a history of uterine tumor that has been done by surgery. Diagnostic test of Multidetector Computed Tomography (MDCT) scan and ultrasonography has been done in this patient, and show a suggestive malignant soft tissue tumor. The surgery has been done with preoperative internal mammary artery embolization to prevent massive bleeding. A 15 cm length, 9 cm wide and 500 grams of weight tumor was evacuated. The immunohistochemistry examination was performed to the tumor specimen, and the result was a leiomyosarcoma tissue. A good examination, early detection with adequate diagnostic tools and adequate surgery as the only option of treatment is a predicting factor of successful treatment, due to lack of treatment option and ineffectiveness use of adjuvant therapy.

Role of Preoperative Embolization in Surgical Management of Carotid Body Tumors: A Systematic Review and Meta-Analysis

The objective of this study is to evaluate the effect of preoperative embolization on carotid body tumor resection. A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed, Scopus, and Web of Science were screened for studies published between 2010 and 2022. Primary outcomes investigated were intraoperative blood loss, operative time, length of hospital stay, and perioperative complications such as transient ischemic attack (TIA)/stroke, vascular injury, and cranial nerve injury (CNI). A random effects model was used in cases where study heterogeneity was high. Overall, 25 studies were included in the systematic review, involving 1649 patients: 23 studies were eligible for meta-analysis. The incidence of vascular injury was significantly less in the preoperative embolization group (odds ratio (OR) = 0.60; 95% CI: 0.42–0.84; P = .003). There was no statistically significant difference between the two groups regarding intraoperative blood loss, operative time, length of hospital stay, incidence of TIA/stroke, and CNI. Subgroup analyses did not demonstrate significant difference between Shamblin I, II, and III subgroups regarding operative time. This meta-analysis found preoperative embolization to be significantly beneficial in reducing incidence of vascular injury.

Clinical and radiological outcomes of n-HA/PA66 cages in anterior spine reconstruction following total en bloc spondylectomy for tumors.

This retrospective monocentric study was conducted to evaluate the clinical and radiological outcomes of the nano-hydroxyapatite/polyamide66 (n-HA/PA66) cage in reconstructing the anterior column of the spine following total en bloc spondylectomy (TES). A cohort of 24 patients, 20 diagnosed with primary malignant tumors and 4 with metastatic malignancies, was selected based on specific inclusion criteria. All were subjected to TES and anterior column reconstruction with the n-HA/PA66 cage from January 2013 to July 2023 at a single institution. Pre-operative embolization was performed on all patients. Documented factors included operation duration, intraoperative blood loss, length of hospital stay, treatment history, and involved level. Mechanical complications and radiological parameters such as the local kyphotic angle (LKA), anterior vertebral height (AVH), posterior vertebral height (PVH), cage subsidence, and bone fusion time were evaluated. Quality of life and neurological function were gauged using tools like the Visual Analog Scale (VAS), Eastern Cooperative Oncology Group (ECOG) performance score, Karnofsky Performance Score (KPS) scale, and American Spinal Injury Association (ASIA) grading. All patients were followed up for 12-127 months, with an average period of 39.71 months. An average operation time of approximately 8.57 h and a blood loss volume of about 1,384 ml were recorded. No instances of tumor recurrence or multiple organ metastases were reported, though recurrence was detected in 2 living patients. Solid fusion was achieved in all patients at a mean time of 6.76 ± 0.69 months. Cage breakage or migration was not observed. Subsidence into the adjacent vertebral bodies was identified in 3 patients but was deemed clinically irrelevant. Significant improvements in VAS, ECOG performance score, KPS scale, and ASIA scores were noted from pre- to post-surgery (P < 0.05). A marked enhancement in the AVH was observed from before surgery to immediately after (P < 0.05). LKA, AVH, and PVH values between postoperative and final follow-up showed no significant variance (P > 0.05). The integration of TES and the n-HA/PA66 cage was found to yield promising clinical and radiological outcomes in anterior column spine reconstruction. The use of this material did not hinder oncological care, including the provision of adjuvant treatments (chemo/radiotherapy), ultimately contributing to the enhanced long-term quality of life for spinal tumor patients.

Preoperative Direct Puncture Embolization Using aNonadhesive Ethylene Vinyl Alcohol (EVOH) Liquid Embolic Agent for Head and Neck Paragangliomas.

This retrospective study aimed to assess the safety and technical efficacy of preoperative direct puncture embolization using anonadhesive ethylene vinyl alcohol (EVOH) copolymer-based liquid embolic agent (LEA) combined with balloon occlusion at the origin of the external carotid artery for head and neck paragangliomas (HNP). We conducted areview of all consecutive cases of HNPs treated with direct puncture embolization using EVOH-based LEAs between 2017 and 2022 in 2 tertiary high-volume hospitals. Atotal of 25cases of HNPs in 24patients underwent direct puncture embolization (12males, 12females, mean age 50.9 ± 15.6 years). The average lesion volume was 299.95 mm3. The mean procedure time was 139.11 min, and the mean volume of EVOHs used per case was 19.38 mL. Successful complete devascularization was achieved in all cases, with ahomogeneous and deep penetration of the embolic agent into the tumor vessel bed regardless of the LEA type. Preoperative embolization of HNPs using adirect puncture technique and EVOHs is asafe, efficient, and feasible treatment option with alow risk of complications. This procedure facilitates surgery by transforming tumors into avascular masses that are well-delineated against the surrounding normal tissue.

A systematic review and meta-analysis on the efficacy of preoperative renal artery embolization prior to radical nephrectomy for renal cell carcinoma: Is it necessary?

Radical nephrectomy for Renal Cell Carcinoma (RCC) is still the treatment of choice for all stages except for stage I and IV, which need patient selectivity. The purpose of Renal Artery Embolization (RAE) pre-operative before radical nephrectomy is to facilitate resection, reduce bleeding, and reduce the time to surgery, but the necessity of this procedure is still debatable. This study investigates the efficacy of pre-operative Renal Artery Embolization (PRAE) before radical nephrectomy for RCC patients. The systematic searches based on PRISMA guidelines were conducted in Pubmed, Scopus, Web of Science, Medrxiv, and ScienceDirect databases with pre-defined keywords. Both analyses, quantitative and qualitative, were performed to assess blood loss, transfusion rate, surgical time, Intensive Care Unit (ICU) stay, and hospital stay. A total of 921 patients from 8 eligible studies were included. The blood loss was significantly lower in the PRAE group compared to the control group (p = < 0.00001; SMD -20 mL; 95%CI -0.29, -0.12). There is no statistically significant difference between RAE and without RAE in the transfusion rate nephrectomy (p = 0.53, OR 0.65; 95% CI 0.16, 2.57), mean operative time (p = 0.69; SMD 5.91; 95% CI -23.25, 35.07), mean length of hospital stay (p = 0.05; SMD 0.56; 95% CI 0.00, 1.12), and mean length of stay in the ICU (p = 0.45; SMD 11.61; 95% CI -18.35, 41.57) Conclusions: PRAE before radical nephrectomy significantly reduces blood loss in RCC patients but is similar in the surgical time, transfusion rate, and length of hospital stay and ICU stay.

Preoperative Renal Artery Embolization Before Radical Nephrectomy for Nonmetastatic Renal Cell Carcinoma: A Propensity Score Matched Analysis

Purpose: This study investigated the effects of preoperative renal artery embolization (PRAE) before radical nephrectomy (RN) for advanced nonmetastatic renal cell carcinoma (RCC) on perioperative and oncologic outcomes.Materials and Methods: We analyzed 820 patients who had undergone RN for advanced nonmetastatic RCC (cT3-4/N0-1) between June 2003 and May 2022. Propensity score matching (PSM) at a 1:2 ratio was performed using the nearest-neighbor method, matching 121 PRAE patients to 242 controls. The primary endpoints included recurrence rate, overall survival, cancer-specific survival, and recurrence-free survival.Results: Before PSM, there were differences in sex (p=0.047), clinical stage (p=0.001), and the Fuhrman grade (p&lt;0.001) between the 2 groups. After PSM, the baseline characteristics were well balanced. The mean age at operation was 58.2±13.0 years, and the median follow-up was 42.0 months. The postoperative transfusion rate was higher in PRAE group (18.2% vs. 10.7%, p=0.049). No significant differences were found between the PRAE and control groups in operation time (166.6±95.3 minutes vs. 155.5±74.2 minutes, p=0.263), estimated blood loss (360.4±732.0 mL vs. 293.4±596.6 mL, p=0.384), or length of hospital stay (7.7±4.9 days vs. 7.7±3.7 days, p=0.961) between the 2 groups. Recurrence was significantly less common in the PRAE group than in the control group (20.7% vs. 34.3%, p=0.007). No significant differences were found in cancer-specific death (8.3% vs. 9.1%, p=0.793) or overall death (8.3% vs. 12.0%, p=0.281). In multivariate logistic regression analysis, clinical T stage ≥3 (odds ratio [OR], 4.365; p&lt;0.001), clinical N stage 1 (OR, 2.405; p=0.020) and no PRAE (OR, 2.293; p=0.004) were independent predictors of recurrence.Conclusions: Our results showed that PRAE was related to a lower recurrence rate. Thus, PRAE seems to be useful before RN for nonmetastatic RCC patients.

Utilisation of the Scepter Mini dual-lumen balloon - An illustrative series.

Dual-lumen balloon microcatheters can aid in the safety and efficacy of endovascular embolisation of cerebrospinal vascular malformations. The Scepter Mini dual-lumen balloon is a novel device with a smaller profile than previous balloon microcatheters, opening up new indications not only in the treatment of cerebrospinal malformations but in various other neurovascular therapeutic and diagnostic scenarios. Following institutional ethics review board approval, a retrospective review of our prospectively maintained database of cases employing the Scepter Mini dual-lumen microballoon catheter was conducted. Five cases in particular were highlighted, demonstrating utilisation of this device, which may be of interest to the Neurointerventionalist. Patient demographics, procedure details, complications and clinical outcome data were reviewed. Five cases employing the Scepter Mini dual-lumen microballoon catheter are presented; trans-arterial embolisation of cerebral AVM, pre-operative tumour embolisation, diagnostic angiography, trans-venous embolisation of cerebral AVM and trans-arterial embolisation of DAVF. No intraprocedural complications were recorded, one patient had a delayed haemorrhage. Potential utilisation of the Scepter Mini lies not only in the trans-arterial embolisation of cerebrospinal vascular malformations, but in a range of other diagnostic and therapeutic indications as demonstrated.

Surgical Options for Aggressive Vertebral Hemangiomas：A case series, literature review and treatment recommendations

PurposeWe retrospectively study twenty-nine surgical cases of aggressive vertebral hemangiomas (AVHs) with neurological deficits and extradural compression to determine the optimal surgical treatment strategy for AVHs at a single institution. MethodsPatients with AVHs with neurological deficits who underwent partial tumor resection plus decompression with or without vertebroplasty (VP), and radiotherapy between 2010 and 2021 were included in this study. Clinical characteristics, surgical outcomes, and follow-up data of the patients were reviewed retrospectively. ResultsTwenty-nine AVH cases with neurological deficits and spinal instability were included in this study and treated surgically. The mean operation time of patients with decompression surgery plus VP (Groupe A) was 215.9 (120-265 min), shorter than that of decompression surgery without VP (Group B) 240.2 (120-320 min). Intraoperative blood loss was 273.3 (100–550 mL) in group A and 635.3 (200–1600 mL) in group B. In addition, a significant reduction in blood loss was observed in group A compared to the group B (p=0.0001). All patients experienced immediate pain relief and improvement in their neurological symptoms. Neurological function was assessed by the Frankel score, ASIA score, and the visual analogue scale (VAS) pain score decreased from 7.4 (4-9) to 1.3 (0-3). Of twenty-nine patients in this study, only 7% (2/29 patients) showed signs of recurrence. ConclusionDecompression plus VP achieve good tumor control and decrease surgical complication. Preoperative vascular embolization and VP can reduce intraoperative bleeding in the treatment of AVH surgery. Moreover, postoperative radiotherapy seems to be a good technique to prevent tumor recurrence.