Safety and efficacy of vascular tumor embolization using Onyx: is angiographic devascularization sufficient? Clinical article
Safety and efficacy of vascular tumor embolization using Onyx: is angiographic devascularization sufficient? Clinical article
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DOI：
10.3171/2009.7.jns09351
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发表时间：
2010-05-01
影响因子：
4.1
通讯作者：
Aziz-Sultan, Mohammad Ali
中科院分区：
文献类型：
--
作者：
Elhammady, Mohamed Samy;Wolfe, Stacey Quintero;Aziz-Sultan, Mohammad Ali
目的。作者评估了 Onyx 栓塞头颈和脊柱肿瘤的安全性和有效性，并确定了肿瘤栓塞与术中失血量之间的相关性。方法。作者前瞻性地收集了 28 个月内在其机构内用 Onyx 栓塞的所有头部、颈部和脊柱肿瘤。评估有关肿瘤类型、位置、肿瘤断流程度、血管内和手术并发症以及术中估计失血量 (EBL) 的信息。结果。 43 名患有各种头部、颈部和脊柱病变的患者接受了 Onyx 血管肿瘤栓塞治疗。栓塞指征包括肿瘤出血未控制8例，择期术前断流术34例，肿瘤引起的消耗性血小板减少症1例。 14例采用直接肿瘤穿刺栓塞，其余病灶采用传统经动脉途径栓塞。栓塞治疗成功结束了所有 8 例患者不受控制的肿瘤出血，并逆转了 1 例消耗性凝血病。所有经皮栓塞的肿瘤以及术前经动脉途径栓塞的 20 个肿瘤中的 4 个肿瘤中，栓塞材料均可能穿透实质内。具有 Onyx 实质内渗透的肿瘤中血管断流的平均百分比为 90.3%，而没有实质内渗透的肿瘤中的平均断血管率为 83.7%。 Onyx 实质内渗透的平均 EBL 显着低于没有实质内渗透的情况（459 vs 2698 ml；p = 0.0067）。没有出现与栓塞手术相关的神经系统并发症。结论。使用 Onyx 栓塞血管肿瘤可以安全地进行，但如果栓塞材料不能穿透肿瘤脉管系统，则可能无法达到减少术中 EBL 的最佳效果。根据作者的经验，实质内穿透的最佳方法是直接穿刺肿瘤。经动脉栓塞可能不会导致肿瘤渗透，特别是通过小口径或慢速血管远距离注射时。 （DOI：10.3171/2009.7.JNS09351）
Object. The authors assessed the safety and efficacy of embolization of head, neck, and spinal tumors with Onyx and determined the correlation between tumor embolization and intraoperative blood loss.Methods. The authors prospectively collected all head, neck, and spinal tumors embolized with Onyx at their institution over a 28-month period. Information on tumor type, location, extent of tumor devascularization, endovascular and surgical complications, and intraoperative estimated blood loss (EBL) was evaluated.Results. Forty-three patients with various head, neck, and spinal lesions underwent vascular tumor embolization with Onyx. Indications for embolization included uncontrolled tumor bleeding in 8 cases, elective preoperative devascularization in 34, and tumor-induced consumptive thrombocytopenia in 1 case. Embolization was performed via direct tumoral puncture in 14 cases and through the traditional transarterial route in the remaining lesions. Embolization was successful in ending uncontrolled tumor bleeding in all 8 cases and in reversing the consumptive coagulopathy in 1 case. Intraparenchymal penetration of embolic material was possible in all percutaneously embolized tumors and in 4 of the 20 tumors embolized preoperatively via the transarterial route. The mean percentage of devascularization in tumors with intraparenchymal penetration of Onyx was 90.3% compared with 83.7% in tumors without intraparenchymal penetration. The mean EBL with intraparenchymal penetration of Onyx was significantly lower than when there was no intraparenchymal penetration (459 vs 2698 ml; p = 0.0067). There were no neurological complications related to the embolization procedures.Conclusions. Embolization of vascular tumors with Onyx can be performed safely but may not reach optimal effectiveness in reducing intraoperative EBL if the embolic material does not penetrate the tumor vasculature. In the authors' experience, the best method of intraparenchymal penetration is achieved with direct tumor puncture. Trans-arterial embolization may not result in tumor penetration, particularly when injected from a long distance through small caliber or slow flow vessels. (DOI: 10.3171/2009.7.JNS09351)