Abstract: Aim: was to investigate the safety and efficacy of transarterial embolization in patients with hypervascular spinal metastases and primary tumors before surgical resection. Materials and methods: 39 patients with spinal metastases and primary tumors underwent angiography and preoperative transarterial embolization with spherical particles, coils and the liquid cohesive composition before surgical resection. Following parameters were evaluated: types of tumor, gender, time interval between embolization and surgery, the influence of these parameters on intraoperative blood loss, surgical content, safety for the patient. Results: Intraoperative blood loss in patients undergoing embolization was up to 500 ml - 29(74,4%), to 1000 mL - 2(5,1%), to 2000 mL - 3(7,7 %), 2000 mL - 5(12,8%). Average value of blood loss for RCC 546,2 ml, for other metastases - 373,5 mL, for primary tumors - 2488,8 mL. There have been no in-hospital mortality related with the intraoperative blood loss. All patients received standard supportive care, emergency blood transfusion was not performed. 3(7,7%) patients after endovascular interventions had complications in the form of temporary neurological deficit, 15 (38,5%) had postembolization syndrome. Conclusion: In the embolization group, intraoperative blood loss was correlated with type of tumor and type of surgical resection. Preoperative embolization is safety and effectively to decrease intraoperative blood loss for patients with hypervascular spinal tumors. References 1. Eastley N., Newey M., Ashford R.U. Skeletal metastases - The role of the orthopaedic and spinalsurgeon. Surgical Oncology. 21 2012; 21: 216-222. 2. Galasko C.S.B., Norris H.E., Crank S. Spinal instability secondary to ^^asta^ cancer. Curr. Concepts Rev. J. Bone Jt Surg (Am) 2000; 82: 570-6. 3. O’Donoghue D.S., Howell A., Walls J. Orthopaedic management of structurally significant bone disease in breast cancer metastases. British Orthopaedic Association; 2011 [guidelines]. 4. Aaron A.D. The management of cancer metastatic to bone. J. Am.Med. Assoc. 1994; 272: 1206-9. 5. Coleman R., Rubens R. The clinical course of bone metastases in breast cancer. Br. J. Cancer. 1987; 77: 336-40. 6. Benati A., Dalle Ore G., Da Pian R., et al. Transfemoral selective embolisation in the treatment of some cranial and vertebro-spinal vascular malformations and tumours: preliminary results. J. Neurosurg. Sci. 1974; 18: 233-38. 7. Wilson M.A., Cooke D.L., Ghodke B. et al. Retrospective analysis of preoperative embolization of spinal tumors. AJNR Am. J. Neuroradiol. 2010 Apr; 31(4): 656-60. doi: 10.3174/ajnr.A1899. Epub 2009 Nov 26. 8. Rangel-Castilla L., Shah A.H., Klucznik R.P et al. Preoperative Onyx embolization of hypervascular head, neck, and spinal tumors. Experience with 100 consecutive cases from a single tertiary center. J. Neurointerv. Surg. 2012; Dec 25. [Epub ahead of print]. 9. Guzman R., Dubach-Schwizer S., Heini P, et al. Preoperative transarterial embolization of vertebral metastases. Eur. Spine J. 2005; 14: 263-68. 10. Manke C., Bretschneider T., Lenhart M., et al. Spinal metastases from renal cell carcinoma: effect of preoperative particle embolization on intraoperative blood loss. AJNR Am. J. Neuroradiol. 2001; 22: 997-1003. 11. Gellad F.E., Sadato N., Numaguchi Y, et al. Vascular metastatic lesions of the spine: preoperative embolization. Radiology. 1990; 176: 683-86. 12. Berkefeld J., Scale D., Kirchner J., et al. Hypervascular spinal tumors: influence of the embolization technique on perioperative hemorrhage. AJNR Am. J. Neuroradiol. 1999; 20: 57-63. 13. Nair S., Gobin YP, Leng L.Z. et al. Preoperative embolization of hypervascular thoracic, lumbar, and sacral spinal column tumors: technique and outcomes from a single center. Interv. Neuroradiol. 2013 Sep; 19(3): 377-85. Epub 2013 Sep 26. 14. Clarengon F., Di Maria F., Cormier E., et al.Onyx injection by direct puncture for the treatment of hypervascular spinal metastases close to the anterior spinal artery: initial experience. J. Neurosurg. Spine. 2013 Jun;.18(6): 606-10. 15. Tokuhashi Y, Matsuzaki H., Oda H. et al. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine. 2005; 30: 2186-2191. 16. Choi D., Crockard A., Tomita K. et al. Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group. Eur. Spine J. 2010; 19(2): 215-222. 17. Chan P, Boriani S., Fourney D.R. et al. An assessment of the reliability of the Enneking and Weinstein-Boriani-Biagini classifications for staging of primary spinal tumors by the Spine Oncology Study Group. Spine ( 18. Tomita K., Kawahara N., Kobayashi T., et al. Surgical strategy for spinal metastases. Spine. 2001; 26: 298-306
