gms | German Medical Science

Objective: We are the first to report one-staged resection of a spinal metastasis from malignant cranial hemangiopericytoma after preoperative Onyx^® embolization by direct percutaneous puncture. Spinal metastases from cranial hemangiopericytoma are extremely rare. Surgical morbidity of these highly vascularized tumours results mainly from excessive blood loss. Preoperative embolization of hypervascular tumours has been used to reduce intraoperative blood loss since long. To avoid complications from arterial catheter intervention, direct percutaneous puncture has been advocated as a safe and effective alternative.

Method: A 46-year-old man with a history of malignant cranial hemangiopericytoma deriving from the left frontal skull base presented with a short history of lower back pain. MRI revealed an intra- and extraspinal mass lesion of the thoracic spine at Th 12. Indication for tumour resection was made and the patient’s written consent was obtained. Preoperatively, arterial catheter angiography was done to learn the tumour’s angioarchitecture revealing high-flow arterio-venous (AV) shunts. In order to impede the expected perioperative blood loss, tumour embolization by direct percutaneous puncture and application of Onyx^® was performed prior to surgery.

Results: After percutaneous Onyx^® embolization, complete and safe resection of the lesion could be achieved. There was only minimal blood loss perioperatively. Pathohistological report confirmed malignant, anaplastic hemangiopericytoma.

Conclusions: Onyx^® embolization via direct percutaneous puncture of highly vascularized tumours seems to be a safe and efficient tool prior to surgery. Even for cases with high-flow AV-shunts direct percutaneous administration of non-adhesive ethanol liquid is an efficient alternative to transarterial catheter embolization. The perioperative blood loss can be substantially diminished.