Embolization of spinal tumors

The purpose of this chapter is to review the clinical features, imaging characteristics, and treatment of various vascular spinal tumors that may benefit from endovascular embolization and then to discuss the principles and technical details of spinal angiography and spinal tumor embolization. Vascular spinal tumors amenable to embolization include hemangioblastomas, hemangiomas, anuerysmal bone cysts, osteoid osteomas, osteoblastomas, giant cell tumors, and metastases, among others. Embolization can be used pre-operatively to reduce blood loss or primarily to reduce pain or prevent tumor progression. Various embolic agents are available including liquid agents such as Onyx (Micro Therapeutics, Inc.) and n-butyl-2-cyanoacrylate (NBCA; Histoacryl, B. Braun, Melsungen, Germany) as well as particulate agents such as polyvinyl alcohol (PVA) and Embospheres (Guerbet Biomedical). Spinal tumor embolization should maximally occlude pathologic tumor supplying vessels while preserving normal blood supply to the spinal cord. Safe and effective endovascular treatment thus depends on careful attention to the relevant angiographic anatomy and technique.