Preoperative Embolization of Metastatic Spinal Cord Compression with n-Butyl Cyanoacrylate: Safety and Effectiveness in Limiting Blood Loss

Abstract

Purpose: To evaluate the safety and effectiveness of preoperative embolization with n-butyl cyanoacrylate (nBCA) performed for metastatic spinal cord compression (MSCC) in limiting blood loss (BL). Materials and Methods: In this institutional review board–approved retrospective study, clinical records from 2017 to 2022 were reviewed. Twenty consecutive patients (11 men and 9 women; mean age, 65.8 years ± 10.0; range, 45–82 years) underwent 21 preoperative spine tumor embolizations with nBCA. Angiograms were used to calculate the percentage reduction in tumor vascularity, and relevant clinical data (levels studied and embolized, fluoroscopy time [FT], reference dose [RD], and Kerma area product [KAP]) and operative data (BL and operative time [OT]) were analyzed. Adverse events and outcomes were recorded. Results: A median of 2 levels were embolized per procedure (range, 1–5) but 4.9 were studied (range, 1–10). After embolization, tumor blush was reduced by a median of 87.3% (range, 50%–90%). The mean FT was 41 minutes ± 15.4 (range, 16–67 minutes), the mean RD was 1,977.1 mGy ± 1,794.3 (range, 450.2–6,319 mGy), and the mean KAP was 180.5 Gy·cm2 ± 166.2 (range, 30.4–504 Gy·cm2). The adverse event rate was 1 (4.7%) of the 21 embolizations because a weakness of lower extremities related to swelling was observed. Surgery was performed at a mean of 1.4 days ± 1 (range, 1–5 days) after embolization. The mean surgical estimated BL was 432.5 mL ± 328.5 (range, 25–1,100 mL), and the mean OT was 210.1 minutes ± 97.4 (range, 57–489 minutes). Conclusions: Preoperative embolization of tumors resected for MSCC with nBCA is a safe procedure allowing for performance of surgery with acceptable BL.