Hypervascular Metastatic Spine Tumor Angiographic Relationships with the Artery of Adamkiewicz and Other Radiculomedullary Arteries

Erick M. Westbroek, A. Karim Ahmed, Zach Pennington, Matthew Goodwin, Yuanxuan Xia, Christine Boone, Philippe Gailloud, Daniel Sciubba

Research output: Contribution to journalArticle

Abstract

Background: Preoperative endovascular embolization of hypervascular metastatic spine tumors can reduce intraoperative blood loss. One frequent objection to embolizing these tumors is the concern for associated arteries feeding the spinal cord, such as the artery of Adamkiewicz. This study aimed to elucidate a relationship between spinal levels affected by hypervascular spine metastases and associated radiculomedullary arteries (RMAs). Methods: A retrospective review of 46 patients who underwent preoperative embolization of hypervascular metastatic spine tumors was conducted. A total of 484 spinal levels were evaluated by diagnostic spinal angiography during embolization procedures. Each spinal level was categorized based on the presence or absence of tumor and RMA. Results: No statistically significant associations were found. The relative risk of affected spinal levels having an associated RMA was 1.10 (95% confidence interval, 0.66–1.85). The attributable risk was 0.01 (−0.01 to 0.02). Chi-squared statistic was 0.13, with a P value of 0.7. Subgroup analysis in renal cell patients was also statistically insignificant, with a relative risk of 0.97 (95% confidence interval, 0.43–2.16). Chi-square statistic was 0.01, with a P value 0.94. A total of 32 patients (69.6%) had an RMA identified on their regional angiogram. Seventeen patients (37%) had an RMA at an embolized level. Conclusions: In this study, no association was found between spinal levels affected by hypervascular metastatic spine tumors and RMAs feeding the spinal cord by diagnostic spinal angiography. This suggests that these tumors have little intrinsic affinity for spinal levels with an RMA. However, given that tumor embolization frequently requires accessing multiple levels, the risk of encountering an RMA during embolization remains significant.

Original languageEnglish (US)
JournalWorld neurosurgery
DOIs
StatePublished - Jan 1 2019

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Spine
Arteries
Neoplasms
Angiography
Spinal Cord
Confidence Intervals
Neoplasm Metastasis
Kidney

Keywords

  • Hypervascular metastases
  • Preoperative embolization
  • Spine oncology
  • Vascular anatomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Hypervascular Metastatic Spine Tumor Angiographic Relationships with the Artery of Adamkiewicz and Other Radiculomedullary Arteries. / Westbroek, Erick M.; Ahmed, A. Karim; Pennington, Zach; Goodwin, Matthew; Xia, Yuanxuan; Boone, Christine; Gailloud, Philippe; Sciubba, Daniel.

In: World neurosurgery, 01.01.2019.

Research output: Contribution to journalArticle

Westbroek, Erick M. ; Ahmed, A. Karim ; Pennington, Zach ; Goodwin, Matthew ; Xia, Yuanxuan ; Boone, Christine ; Gailloud, Philippe ; Sciubba, Daniel. / Hypervascular Metastatic Spine Tumor Angiographic Relationships with the Artery of Adamkiewicz and Other Radiculomedullary Arteries. In: World neurosurgery. 2019.
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abstract = "Background: Preoperative endovascular embolization of hypervascular metastatic spine tumors can reduce intraoperative blood loss. One frequent objection to embolizing these tumors is the concern for associated arteries feeding the spinal cord, such as the artery of Adamkiewicz. This study aimed to elucidate a relationship between spinal levels affected by hypervascular spine metastases and associated radiculomedullary arteries (RMAs). Methods: A retrospective review of 46 patients who underwent preoperative embolization of hypervascular metastatic spine tumors was conducted. A total of 484 spinal levels were evaluated by diagnostic spinal angiography during embolization procedures. Each spinal level was categorized based on the presence or absence of tumor and RMA. Results: No statistically significant associations were found. The relative risk of affected spinal levels having an associated RMA was 1.10 (95{\%} confidence interval, 0.66–1.85). The attributable risk was 0.01 (−0.01 to 0.02). Chi-squared statistic was 0.13, with a P value of 0.7. Subgroup analysis in renal cell patients was also statistically insignificant, with a relative risk of 0.97 (95{\%} confidence interval, 0.43–2.16). Chi-square statistic was 0.01, with a P value 0.94. A total of 32 patients (69.6{\%}) had an RMA identified on their regional angiogram. Seventeen patients (37{\%}) had an RMA at an embolized level. Conclusions: In this study, no association was found between spinal levels affected by hypervascular metastatic spine tumors and RMAs feeding the spinal cord by diagnostic spinal angiography. This suggests that these tumors have little intrinsic affinity for spinal levels with an RMA. However, given that tumor embolization frequently requires accessing multiple levels, the risk of encountering an RMA during embolization remains significant.",
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AU - Xia, Yuanxuan

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AU - Gailloud, Philippe

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N2 - Background: Preoperative endovascular embolization of hypervascular metastatic spine tumors can reduce intraoperative blood loss. One frequent objection to embolizing these tumors is the concern for associated arteries feeding the spinal cord, such as the artery of Adamkiewicz. This study aimed to elucidate a relationship between spinal levels affected by hypervascular spine metastases and associated radiculomedullary arteries (RMAs). Methods: A retrospective review of 46 patients who underwent preoperative embolization of hypervascular metastatic spine tumors was conducted. A total of 484 spinal levels were evaluated by diagnostic spinal angiography during embolization procedures. Each spinal level was categorized based on the presence or absence of tumor and RMA. Results: No statistically significant associations were found. The relative risk of affected spinal levels having an associated RMA was 1.10 (95% confidence interval, 0.66–1.85). The attributable risk was 0.01 (−0.01 to 0.02). Chi-squared statistic was 0.13, with a P value of 0.7. Subgroup analysis in renal cell patients was also statistically insignificant, with a relative risk of 0.97 (95% confidence interval, 0.43–2.16). Chi-square statistic was 0.01, with a P value 0.94. A total of 32 patients (69.6%) had an RMA identified on their regional angiogram. Seventeen patients (37%) had an RMA at an embolized level. Conclusions: In this study, no association was found between spinal levels affected by hypervascular metastatic spine tumors and RMAs feeding the spinal cord by diagnostic spinal angiography. This suggests that these tumors have little intrinsic affinity for spinal levels with an RMA. However, given that tumor embolization frequently requires accessing multiple levels, the risk of encountering an RMA during embolization remains significant.

AB - Background: Preoperative endovascular embolization of hypervascular metastatic spine tumors can reduce intraoperative blood loss. One frequent objection to embolizing these tumors is the concern for associated arteries feeding the spinal cord, such as the artery of Adamkiewicz. This study aimed to elucidate a relationship between spinal levels affected by hypervascular spine metastases and associated radiculomedullary arteries (RMAs). Methods: A retrospective review of 46 patients who underwent preoperative embolization of hypervascular metastatic spine tumors was conducted. A total of 484 spinal levels were evaluated by diagnostic spinal angiography during embolization procedures. Each spinal level was categorized based on the presence or absence of tumor and RMA. Results: No statistically significant associations were found. The relative risk of affected spinal levels having an associated RMA was 1.10 (95% confidence interval, 0.66–1.85). The attributable risk was 0.01 (−0.01 to 0.02). Chi-squared statistic was 0.13, with a P value of 0.7. Subgroup analysis in renal cell patients was also statistically insignificant, with a relative risk of 0.97 (95% confidence interval, 0.43–2.16). Chi-square statistic was 0.01, with a P value 0.94. A total of 32 patients (69.6%) had an RMA identified on their regional angiogram. Seventeen patients (37%) had an RMA at an embolized level. Conclusions: In this study, no association was found between spinal levels affected by hypervascular metastatic spine tumors and RMAs feeding the spinal cord by diagnostic spinal angiography. This suggests that these tumors have little intrinsic affinity for spinal levels with an RMA. However, given that tumor embolization frequently requires accessing multiple levels, the risk of encountering an RMA during embolization remains significant.

KW - Hypervascular metastases

KW - Preoperative embolization

KW - Spine oncology

KW - Vascular anatomy

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