Background and ObjectivesPreoperative embolization of metastatic spinal tumors (MSTs) has proven advantageous in limiting intraoperative blood loss (IBL) during resection. N-butyl cyanoacrylate (nBCA) is a liquid embolic agent known for its rapid hemostatic effects. However, nBCA is associated with a higher risk of distal nontarget embolization. This study highlights the refinement of the embolization technique and assesses its efficacy in performing an initial distal segmental artery plug with concentrated nBCA followed by proximal diluted nBCA for MSTs.MethodsA retrospective review of patients with MST (2018–2023) was performed. Patients who underwent preoperative nBCA endovascular embolization prior to tumor resection and spinal instrumentation were included. Baseline standard spinal angiography was performed.ResultsSixteen patients (13 men, 3 women; 56.0 ± 12.4 years) met inclusion criteria. And 43.75% (7 of 16) had thoracic levels, 37.5% (6 of 16) lumbar, and 18.75% (3 of 16) sacral. The most common primary tumor was renal cell carcinoma (43.75%, 7 of 16). A total of 43 pedicles were embolized (median 3), resulting in complete/near complete obliteration of the tumor blush. Most pedicles (83.7%, 36 of 43) received a single dilute concentration of nBCA; however, 16.3% (7 of 43) received two separate concentrations of nBCA, a denser concentration distally into the segmental artery and a diluted concentration proximally into the tumor bed. Mean IBL was 1150 ± 1201 mL in 3 distal plug patients distal plug patients versus 1625 ± 681 mL in 12 other patients. There were no complications related to embolization.ConclusionPerforming a distal, concentrated nBCA plug during preoperative nBCA embolization of MSTs may increase tumor penetration and reduce IBL.

中文翻译：

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nBCA栓塞技术治疗脊柱转移瘤的完善：病例系列和技术报告

背景和目的转移性脊柱肿瘤（MST）的术前栓塞已被证明有利于限制切除过程中的术中失血（IBL）。氰基丙烯酸正丁酯 (nBCA) 是一种液体栓塞剂，以其快速止血作用而闻名。然而，nBCA 与远端非目标栓塞的较高风险相关。本研究强调了栓塞技术的改进，并评估了其在使用浓缩 nBCA 进行初始远端节段动脉栓塞，然后使用近端稀释 nBCA 进行 MST 的疗效。方法对 MST 患者（2018-2023 年）进行了回顾性评价。包括在肿瘤切除和脊柱内固定术之前接受术前 nBCA 血管内栓塞的患者。进行基线标准脊柱血管造影。结果 16 名患者（13 名男性，3 名女性；56.0 ± 12.4 岁）符合纳入标准。43.75%（16 人中的 7 人）有胸椎，37.5%（16 人中的 6 人）有腰椎，18.75%（16 人中的 3 人）有骶椎。最常见的原发性肿瘤是肾细胞癌（43.75%，16 例中有 7 例）。总共 43 个蒂被栓塞（中位数 3 个），导致肿瘤红肿完全/接近完全消失。大多数椎弓根（83.7%，43 个中的 36 个）接受单一稀释浓度的 nBCA；然而，16.3%（43 人中的 7 人）接受了两种不同浓度的 nBCA，远端进入节段动脉的浓密浓度和近端进入肿瘤床的稀释浓度。3 名远端插头患者的平均 IBL 为 1150 ± 1201 mL，而其他 12 名患者的平均 IBL 为 1625 ± 681 mL。没有与栓塞相关的并发症。结论在MST术前nBCA栓塞过程中进行远端集中nBCA栓可能会增加肿瘤渗透并减少IBL。