Embolization of intradural vascular spinal cord tumors : report of five cases and review of the literature.

INTRODUCTION: Spinal cord tumors (SCT) are best treated by surgery. Vascular SCT (VSCT) represent a special challenge because of the bleeding that may occur during surgery and the subsequent difficulties in operating on these lesions. Embolization has been proposed as an approach that would facilitate VSCT resection.
METHODS: The clinical and radiological charts of five patients, each with a large solid VSCT (four cervical hemangiobastomas, one filum terminale paraganglioma), were retrospectively reviewed. All of these hypervascular lesions were superselectively embolized prior to surgery (four with N-butyl cyanoacylate (glue), one with particles).
RESULTS: Intranidal deposition of the glue was successful in all four patients, resulting in significant devascularization of the tumor. Because of arterial tortuosities, it was not possible to reach distally a cervical hemangioblastoma, and the latter was consequently embolized with particles. No permanent complications arose after embolization. Surgery became possible in each case under improved conditions with minimal blood loss, thereby allowing total (four cases of hemangioblastomas) or subtotal (one case of paraganglioma) removal of the tumor.
CONCLUSION: Embolization of intradural vascular tumors is a safe procedure if applied according to strict anatomical and technical guidelines. Whenever possible, glue can be considered as a first intention embolus, particles being reserved to cases where selectivity cannot be achieved. Despite its solid aspect after deposition, glue does not hinder surgery but facilitates the manipulation and eradication of the tumor. Due to its initial liquid aspect, glue penetrates deeply into the tumoral capillary bed, which favors satisfactory devascularization of the lesion.