Transcatheter Therapy for Tumors of the Spine

Common metastatic hypervascular tumors involving the spinal column originate from renal cell carcinoma and, less commonly, thyroid carcinoma (1). Metastatic breast, liver, and squamous cell carcinoma as well as melanoma and metastatic angiosarcoma (2) can also be hypervascular (3). The most common primary tumors of the spine that are hypervascular are aggressive hemangiomas and aneurysmal bone cysts (ABCs). Many have recommended routine preoperative embolization for these tumors to decrease blood loss at surgery with the additional hope of making the tumor resection more complete (1–18). Other rarer tumors known to be hypervascular, and for which embolization may also be indicated, include benign tumors (osteoblastoma [19], osteoid osteoma [20], chondroma), malignant tumors (giant cell tumor [12], chordoma, osteogenic sarcoma, chondrosarcoma, hemangiopericytoma [21], lymphoma, multiple myelorna, plasmacytoma), and spinal cord tumors (hemangioblastoma) (Fig. 1) (22, 46). According to the Accreditation Council on Graduate Medical Education (22) training program requirements, more than 95% of the spinal column embolization procedures should be performed for these diagnoses. Patients suffering from these bone tumors often present with pain or neurological deficits (weakness, numbness, loss of bowel or bladder function). This is usually secondary to compression of the spinal cord or nerves by soft tissue spread of the osseous process or by expansion of the vertebral body margins. This chapter details the indications for treatment, pertinent anatomy, preprocedure care, embolization technique, and postprocedure care of patients with hypervascular tumors of the spine.