Preoperative embolization of spinal tumors: A systematic review and meta-analysis.

Preoperative embolization of spinal tumors: A systematic review and meta-analysis.

World Neurosurg. 2015 Dec 15;

Authors: Griessenauer CJ, Salem M, Hendrix P, Foreman PM, Ogilvy CS, Thomas AJ

Abstract
BACKGROUND: Spinal tumors are referred for preoperative embolization to minimize intraoperative blood loss and facilitate surgical resection.
OBJECTIVE: To perform a systematic review and meta-analysis and provide comprehensive data on embolization technique, efficacy, and complications.
METHODS: A systematic review of PubMed articles was performed with the following inclusion criteria: original studies, studies of ≥ 10 patients (except Onyx due to scarcity of available data), embolization through vascular access, and reporting of the embolic agent used. Additionally the manuscript needed to contain at least one of the following variables: demographics, tumor type, location, vascularity, degree of devascularization, complications, time to operation, type of operation, estimated blood loss (EBL), and use of blood transfusion.
RESULTS: Thirty-seven studies with a total of 1,305 patients met inclusion criteria. Renal cell carcinoma was the most commonly embolized tumor comprising 47.4% (95% CI 39.4 – 55.4) of all tumor embolizations. The rate of complete devascularization for all tumor types was 68.3% (95% CI 60.0 – 76.6). There was a significant decrease in operative EBL in more recently published studies as compared to earlier studies, however, the rate of complete embolization remained stable. Polyvinyl alcohol (PVA) and Onyx(®) were associated with similar EBL and rates of complete embolization. The overall complication rate was 3.1% (95% CI 1.2 – 4.9).
CONCLUSIONS: The rapid evolution of neurointervention and spinal tumor embolization has made scientific inquiry and definitive conclusion on the safety and efficacy of the practice difficult. The data supporting the procedure is fragmented and largely based on a multitude of retrospective studies utilizing varying techniques. Review of the available literature support embolization of spinal tumors as a safe and efficacious treatment adjunct prior to surgery.

PMID: 26704206 [PubMed – as supplied by publisher]

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