Preoperative tumor embolization via pedicle artery sacrifice for symptomatic spinal aneurysmal bone cysts: illustrative cases. J Neurosurg Case Lessons 2025 Mar 03;9(9)
Date
03/05/2025Pubmed ID
40030147Pubmed Central ID
PMC11877370DOI
10.3171/CASE24580Scopus ID
2-s2.0-86000528007 (requires institutional sign-in at Scopus site)Abstract
BACKGROUND: Spinal aneurysmal bone cysts (ABCs) are challenging to manage due to high vascularity and proximity to critical structures. Two patients with large, symptomatic thoracic ABCs are presented.
OBSERVATIONS: Preoperative tumor embolization via pedicle artery sacrifice was performed prior to planned resection to reduce intraoperative blood loss and the risk of postoperative neurological deficits. Less intraoperative blood loss contributes to better surgical visualization and patient stability, thereby promoting maximal safe tumor resection with reduced neurological morbidity. Coil embolization was selected in both cases due to lower risks of nontarget embolization given local feeders to the anterior spinal artery. Provocative methohexital and lidocaine testing was performed with intraoperative monitoring to minimize risk prior to embolizing each vessel.
LESSONS: The indications for preoperative embolization for spinal ABCs remain controversial. The risks associated with this embolization strategy, including those inherent to spinal angiography and embolization as well as increased costs, are potentially outweighed by the benefits of decreased intraoperative blood loss to maximize surgical safety and risks in select patients. In both cases, complete tumor resection was achieved, with the patients experiencing no adverse effects due to embolization, lower-than-expected intraoperative blood loss, and near-complete return of neurological function. https://thejns.org/doi/10.3171/CASE24580.
Author List
Davis J, Langman M, Torio EF, Kim I, Lew SM, Tassone JC, Nerva JDAuthors
Irene Kim MD Associate Professor in the Neurosurgery department at Medical College of WisconsinSean Lew MD Chief, Professor in the Neurosurgery department at Medical College of Wisconsin
John D. Nerva MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin
J Channing Tassone MD Chief, Professor in the Orthopaedic Surgery department at Medical College of Wisconsin
