Embolization of Spinal Cord Tumours

Abstract

Spinal cord neoplasms comprise a large spectrum of lesions among which hemangioblastomas (HMGBL) and paragangliomas (PGGLs) represent the most important vascular spinal cord tumours (VSCT). The standard treatment of these lesions is total surgical resection whenever possible. En bloc dissection and resection of the lesion is the approach of choice as it provides the best option to avoid tumoral haemorrhages. However, this surgical technique is particularly challenging, and sometimes even not possible. Optimal surgical treatment can thus be facilitated by presurgical embolization of the VSCT. The endovascular management of spinal cord tumours should be considered as a double challenge: related to the vascular anatomy of the spinal cord in order to understand what can be achieved in safe clinical conditions, and linked to the technique used in order to allow proper distal intratumoral devascularization. The embolic agent has to be chosen according to the aspect of the vasculature and the tumoral blush. Particles and glue are the most frequently used emboli. To achieve proper devascularization, they have to be deposited inside the tumoral capillary bed after distal transarterial navigation with thin microcatheters. The devascularization of a lesion not only induces per operative bloodless intratumoral fragmentation in order to facilitate its resection, but also allows tumoral necrosis and shrinkage of the lesion, which may improve its dissection and separation from the adjacent nervous tissue. Thus, it increases the chances for total removal, lowers the rates of recurrence, shortens operation time, and reduces surgical morbidity. In our experience, no permanent complications occurred after embolization of VSCT. The various neurosurgeons operating on these patients have considered embolization to be an important application in the overall therapeutic management of these diseases as it allowed total resection of the lesions in improved or non haemorrhagic conditions. The place of embolization with glue as sole treatment of certain VSCT remains to be precised.