Preoperative Onyx Embolization of Aggressive Vertebral Hemangiomas

SPINE CASE REPORT Preoperative Onyx Embolization of Aggressive CASE REPORT Vertebral Hemangiomas M.C. Hurley SUMMARY: We report the first use of Onyx in the embolization of spinal tumors in 2 cases of aggressive vertebral hemangioma. In both cases, Onyx embolization provided effective preoperative B.A. Gross tumor devascularization after the initial prolonged particulate embolization with Embospheres made D. Surdell little overall impact. Onyx enables a more rapid and visible embolization than particles and is less A. Shaibani technically demanding than traditional liquid embolic agents, such as n-butyl cyanoacrylate. K. Muro C.M. Mitchell E.M. Doppenberg B.R. Bendok reoperative embolization of vascular spinal tumors mini- over 1 hour and replacing 2 obstructed catheters, repeat angiography Pmizes perioperative hemorrhage and facilitates resection. showed minimally reduced tumor supply (Fig 2B). After changing to Particulate agents, including Embosphere (BioSphere Medi- a DMSO-compatible Rebar-18 microcatheter (ev3), injected On- cal, Rockland, Mass) and polyvinyl alcohol (PVA) are favored, yx-18 tended to reflux early, resulting in feeder occlusion without because they penetrate the capillary bed beyond potential ar- small-vessel penetration (Fig 2C). teriolar anastomoses. A small number report successful use of Subsequent sequential embolizations of right L1, L2, and left L1 polymerizing liquid agents, such as n-butyl cyano acrylate (n- arteries, initiated with the more concentrated Onyx-34 to form a du- BCA; Cordis Neurovascular, Miami Lakes, Fla), in embolizing rable plug around the catheter tip and completed with Onyx-18, re- head and neck neoplasms. sulted in deeper penetration of the tumor bed (Fig 2D). Approxi- Onyx (ev3, Irvine, Calif)...