Advertisement

Embolization of Spinal Cord Tumours

  • Georges RodeschEmail author
  • Stephan Gaillard
  • Hughes Loiseau
  • Sorin Aldea
Chapter
  • 1.1k Downloads
Part of the Tumors of the Central Nervous System book series (TCNS, volume 6)

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.

Keywords

Anterior Spinal Artery Lumbar Enlargement Radicular Artery Ventral Sulcus Intradural Spinal Tumor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Balériaux D, Parizel P, Bank WO (1992) Intraspinal and intramedullary pathology. In: Manelfe C (ed) Imaging of the spine and spinal cord. Raven Press Ltd, New York, pp 513–564Google Scholar
  2. Berenstein A, Lasjaunias P, TerBrugge K (2004) Spinal cord tumours. In: Berenstein A, Lasjaunias P, TerBrugge K (eds) Surgical neuroangiography, vol 2.2, 2nd edn, Clinical and endovascular treatment aspects in adults. Springer, New York, pp 898–909CrossRefGoogle Scholar
  3. Bhattacharya J, Luo CB, Suh DS, Alvarez H, Rodesch G, Lasjaunias P (2001) Wyburn-Mason or Bonnet-Dechaume-Blanc as cerebro-facial arteriovenous metameric syndromes (CAMS). A new concept and a new classification. Interv Neuroradiol 7:5–17PubMedGoogle Scholar
  4. Biondi A, Ricciardi G, Faillot T, Capelle L, Van Effenterre R, Chiras J (2005) Hemangioblastomas of the lower spinal region: report of four cases with preoperative embolization and review of the literature. Am J Neuroradiol 26:936–945PubMedGoogle Scholar
  5. Brotchi J (2002) Intrinsic spinal cord tumor resection. Neurosurgery 50:1059–1063PubMedGoogle Scholar
  6. Brotchi J, Lefranc F (1999) Current management of spinal cord tumours. Contemp Neurosurg 21:1–7Google Scholar
  7. Brown TR, Adams RD, Roberson GH (1976) Hemangioblastoma of the spinal cord: review and report of 5 cases. Arch Neurol 33:435–441CrossRefGoogle Scholar
  8. Choi IS, Tantivatana J (2000) Neuroendovascular management of intracranial and spinal tumors. Neurosurg Clin N Am 11:167–185PubMedGoogle Scholar
  9. Colombo N, Kucharczyk W, Brant-Zawadzki M, Norman D, Scotti G, Newton TH (1986) Magnetic resonance imaging of spinal cord hemangioblastoma. Acta Radiol Diagn 369(suppl):734–737Google Scholar
  10. Cristante L, Hermann HD (1999) Surgical management of intramedullary hemangioblastoma of the spinal cord. Acta Neurochir (Wien) 141:333–340CrossRefGoogle Scholar
  11. David P, Hurth M (1995) Tumeurs intramédullaires. In: Decq P, Keravel Y (eds) Neurochirurgie. Edition Ellipses, Paris, pp 423–430Google Scholar
  12. Di Chiro G, Doppman JL (1969) Differential angiographic features of hemangioblastomas and arteriovenous malformations of the spinal cord. Radiology 93:25–30PubMedGoogle Scholar
  13. Eskridge JM, McAuliff W, Harris B, Kim DK, Scott J, Winn HR (1996) Preoperative endovascular embolization of craniospinal hemangioblastomas. AJNR Am J Neuroradiol 17:525–531PubMedGoogle Scholar
  14. Hermann CL (1999) Surgical management of intramedullary hemangioblastoma of the spinal cord. Acta Neurochir 141:333–339CrossRefGoogle Scholar
  15. Ho VB, Smirniotopoulos JG, Murphy FM, Rushing EJ (1992) Radiologic-pathologic correlation: hemangioblastoma. AJNR Am J Neuroradiol 13:1343–1352PubMedGoogle Scholar
  16. Houten JK, Babu RP, Miller DC (2002) Thoracic paraganglioma presenting with spinal cord compression and metastases. J Spinal Disord Tech 15:319–323PubMedCrossRefGoogle Scholar
  17. Hurth M (1975) Intraspinal hemangioblastomas. Neurochirurgie 21:1–136PubMedGoogle Scholar
  18. Lasjaunias P, Berenstein A, TerBrugge K (2001) Spine and spinal cord arteries and veins. In: Berenstein A, Lasjaunias P, TerBrugge K (eds) Surgical neuroangiography, vol 1, 2nd edn, Clinical vascular anatomy and variations. Springer, New York, pp 73–164Google Scholar
  19. Levy RA (1993) Paragangliomas of the filum terminale. MR findings. AJR Am J Roentgenol 160:851–852PubMedGoogle Scholar
  20. Lonser RR, Oldfield EH (2006) Spinal cord hemangioblastomas. Neurosurg Clin N Am 17:37–44PubMedCrossRefGoogle Scholar
  21. Neumann HP, Eggert HR, Weigel K, Friedburg H, Wiestler OD, Schollmeyer P (1989) Hemangioblastomas of the central nervous system: a 10-year study with special reference to Von Hippel Lindau syndrome. J Neurosurg 70:24–30PubMedCrossRefGoogle Scholar
  22. Neumann HP, Eggert HR, Scheremet R, Schumacher M, Mohadjer M, Wakhloo AJ, Volk B, Hettmansperger U, Riegler P, Schollmeyer P (1992) Central nervous system lesions in Von Hippel Lindau syndrome. J Neurol Neurosurg Psychiatry 55:898–901PubMedCrossRefGoogle Scholar
  23. Osborn A (1994) Tumors, cysts, and tumor-like lesions of the spine and spinal cord, chap 21. In: Osborn A (ed) Diagnostic neuroradiology. Mosby Year Book, St Louis, pp 876–918Google Scholar
  24. Parsa AT, Lee J, Parney IF, Weinstein P, McCormick PC, Ames C (2004) Spinal cord and intradural-extraparenchymal spinal tumors: current best care practices and strategies. J Neurooncol 69:291–318PubMedCrossRefGoogle Scholar
  25. Rodesch G, Gaillard S, Loiseau H, Brotchi J (2008) Embolization of intradural vascular spinal cord tumors. Report of five cases and review of the literature. Neuroradiology 50:145–151PubMedCrossRefGoogle Scholar
  26. Rubinstein LJ (1972) Tumors of the central nervous system. In: Rubinstein LJ (ed) Atlas of tumor pathology. Fasc 6. United States Armed Forces Institute of Pathology, Washington, DC, pp 10–12Google Scholar
  27. Russel DS, Rubinstein LJ (1989) Tumors of vascular origin. Chapter 9. In: Russel DS, Rubinstein LJ (eds) Pathology of tumors of the nervous system. Edward Arnold, cop, London, pp 639–663Google Scholar
  28. Sankhla S, Kham GM (2004) Cauda equina paraganglioma presenting with intracranial hypertension: case report and review of the literature. Neurol India 52:243–244PubMedGoogle Scholar
  29. Tampieri D, Leblanc R, Terbrugge K (1993) Preoperative embolization of brain and spinal hemangioblastomas. Neurosurgery 33:502–505PubMedCrossRefGoogle Scholar
  30. Thron AK (1988) Vascular anatomy of the spinal cord. Neuroradiological investigations and clinical syndromes. Springer, New YorkCrossRefGoogle Scholar
  31. Wanebo J, Lonser R, Glenn G, Oldfield E (2003) The natural history of hemangioblastomas of the central nervous system in patients with Von Hippel Lindau disease. J Neurosurg 98:82–94PubMedCrossRefGoogle Scholar
  32. Xu QW, Bao WM, Mao RL, Yang GY (1994) Magnetic resonance imaging and microsurgical treatment of intramedullary hemangioblastoma of the spinal cord. Neurosurgery 35:671–676PubMedCrossRefGoogle Scholar
  33. Yang SY, Jin YJ, Park SH, Jahng TA, Kim HJ, Chung CK (2005) Paragangliomas in the cauda equina region: clinicopathoradiologic findings in 4 cases. J Neurooncol 72:49–55PubMedCrossRefGoogle Scholar
  34. Yasargil MG (1978) Operative treatment of spinal angioblastomas. In: Pia HW, Djindjian R (eds) Spinal angiomas: advances in diagnosis and therapy. Springer, New YorkGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Georges Rodesch
    • 1
    Email author
  • Stephan Gaillard
    • 1
  • Hughes Loiseau
    • 1
  • Sorin Aldea
    • 1
  1. 1.Service de Neuroradiologie Diagnostique et ThérapeutiqueHôspital FochSuresnesFrance

Personalised recommendations