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Embolization as treatment for spinal cord compression from renal cell
carcinoma: case report.
Strategy for the treatment of patients with spinal neoplasms.
[Arterial embolization as a therapeutic possibility of tumors of the
skeletal system].
Treatment of neoplastic spinal cord compression: results of a prospective
study.
Vertebral body resection in the treatment of cancer involving the spine.
Surgical treatment of metastatic spine disease.
Metastatic disease of the spine.
Percutaneous injection of an alcoholic embolizing emulsion as an alternative
preoperative embolization for spine tumor.
Use of preoperative vascular embolisation in spinal metastasis resection.
Embolization of paraspinal masses.
Preoperative superselective arteriolar embolization: a new approach to
enhance resectability of spinal tumors.
[Preoperative embolization of cervical bone metastasis with radio-controlled
direct puncture].
Preoperative embolization of spinal tumors.
[Surgical treatment of primary and secondary malignant tumors of the
thoracic and lumbar spine].
Preoperative embolization of cervical spine tumors.
Preoperative transarterial embolization of spinal column neoplasms.
Surgical management of metastatic renal carcinoma of the spine.
[Embolization of metastases of the mobile spine].
Tumor devascularization by intratumoral ethanol injection during surgery.
Technical note.
Vascular metastatic lesions of the spine: preoperative embolization.
Transarterial embolization of vertebral hemangioma.
Surgical treatment of metastatic tumors of the spine.
Therapeutic embolization of symptomatic secondary renal tumors.
[Interventional therapy of primary and secondary tumors of the spine].
Hypervascular spinal tumors: influence of the embolization technique on
perioperative hemorrhage.
Arterial embolization of bone metastases: is it worthwhile?

Neurosurgery 1996 Dec;39(6):1260-2; discussion 1262-3
Embolization as treatment for spinal cord compression from renal cell
carcinoma: case report.
Kuether TA, Nesbit GM, Barnwell SL
Division of Neurosurgery, Oregon Health Sciences University, Portland, USA.
OBJECTIVE AND IMPORTANCE: Metastatic renal cell carcinoma may involve the
vertebrae, resulting in acute spinal cord compression. Embolization has been
used to reduce operative blood loss during surgical decompression, but it
has not been considered as an alternative that may eliminate the need for
open debulking. CLINICAL PRESENTATION: A case is presented of a 30-year-old
woman with renal cell carcinoma who developed increasing severe back pain,
lower extremity weakness, and sensory loss. Magnetic resonance evaluation
revealed a T5 metastasis, resulting in significant spinal cord compression.
INTERVENTION: Transarterial embolization was performed with polyvinyl
alcohol particles and platinum microcoils. One month after embolization, the
patient's lower extremity strength and sensation had improved, and magnetic
resonance imaging demonstrated a dramatic response with a significant
reduction of cord compression. She deteriorated again 4 months later, and a
new sacral mass was embolized. She again improved after treatment.
CONCLUSION: This report illustrates that embolization may be used as
palliative treatment for spinal cord compression and obviate the need for
open surgical decompression.

Spinal Cord 1997 Jul;35(7):429-36
Strategy for the treatment of patients with spinal neoplasms.
Kluger P, Korge A, Scharf HP
Orthopadische Abteilung im RKU, Universitat Ulm, Germany.
Progress in oncological therapy within the last decade has enhanced the
survival time of patients suffering from tumorous osteolyses of the spine.
While the necessity of surgical intervention is often settled by acute
clinical symptoms, the extent of surgery is certainly co-determined by the
patient's expectations and the time of survival to be expected. We therefore
developed a specific tumor algorithm for operations on the spine with
special emphasis on prognosis and the attainable quality of life. The
results of 154 patients with tumorous osteolyses of the thoracic and lumbar
spine, who were treated according to our algorithm, underline the
unequivocal advantages of initially posterior procedures.

Aktuelle Traumatol 1994 May;24(3):87-90
[Arterial embolization as a therapeutic possibility of tumors of the
skeletal system].
[Article in German]
Bernd L, Ewerbeck V, Richter G
Orthopadische Universitatsklinik Heidelberg.
Arterial embolization is an approved method in treating bleeding tumors of
the urogenital tract. In orthopedic patients it has been applied for
hypervascularized skeletal metastases of the pelvic, spine and long bones.
Intraoperative blood loss with its known risks can be markedly reduced.
Reduction of pain has also been reported. The good results in our series of
9 patients together with the low incidence of side effects suggest that
arterial embolization is indicated on a large scale.

Neurosurgery 1991 Nov;29(5):645-50
Treatment of neoplastic spinal cord compression: results of a prospective
study.
Sundaresan N, Digiacinto GV, Hughes JE, Cafferty M, Vallejo A
Department of Neurosurgery, Mt. Sinai Medical Center, New York, New York.
Currently, external radiation and steroid therapy are used in most patients
with neoplastic spinal cord compression. Surgery is generally used to treat
those who do not respond to radiation therapy. To determine the role of de
novo surgery in patients with spinal metastases, a prospective study was
undertaken. Over a 4 1/2-year period, the cases of 54 patients with
radiologically documented spinal metastases were studied. The sites of tumor
origin included soft tissue sarcoma (8 patients), kidney (6 patients), lung
(5 patients), breast (5 patients), spine (6 patients), unknown primary site
(6 patients), and others (18 patients). Sites of compression included the
cervical spine segments in 15 patients, thoracic segments in 23, lumbar in
14, and sacral in 2. Before surgery, 24 patients (44%) were nonambulatory.
Three surgical approaches were used: anterior vertebral body resection in 45
patients, laminectomy in 7, and lateral osteotomy in 2. After surgery, 37
patients received external radiation therapy. All patients improved (became
ambulatory) after surgery, with 23 of 25 patients surviving at 2 years
continuing to be ambulatory. The 30-day mortality rate was 6% (three
patients); eight patients (15%) sustained various surgical complications.
These results are superior to those reported after external radiation
therapy and steroids alone, and they support the concept that de novo
surgery be considered in selected patients with spinal metastases.

Cancer 1984 Mar 15;53(6):1393-6
Vertebral body resection in the treatment of cancer involving the spine.
Sundaresan N, Galicich JH, Bains MS, Martini N, Beattie EJ Jr
Results of radical spinal surgery with vertebral body resection in of 51
patients with primary and metastatic cancer of the spine were analyzed.
Seven patients had primary spine tumors, 16 had paravertebral tumors that
involved the spine by direct extension, and 28 had blood-borne metastases to
the spine. Thirty-five patients (68%) had prior therapy directed to the
spine: 4 had undergone previous surgery, 9 had surgery and radiation, and 22
had radiation alone. Forty-five patients (90%) had intractable pain, and 25
patients (48%) were nonambulatory. Myelography revealed high-grade or
complete block in 39 patients (76%). Following surgery, 38 of 45 (84%) had
pain relief, and 40/58 (78%) were ambulatory at discharge. Of the 25
patients who were unable to walk prior to surgery, 15 (60%) improved to
fully ambulatory status. The surgical mortality was low (4%), and
complications were few (10%). These results are superior to those reported
following treatment by radiation and steroid therapy. In selected patients
who have actual or potential neural compression resulting from tumor within
the vertebral body, such surgery should be considered as initial therapy.

Spine 1992 Oct;17(10):1148-53
Surgical treatment of metastatic spine disease.
Hammerberg KW
Department of Orthopedic Surgery, Rush Presbyterian St. Luke's Medical
Center, Chicago, Illinois.
The results of surgical intervention for metastatic disease on 56
consecutive patients since 1980 were reviewed. Two patients underwent a
second procedure to stabilize remote levels of spinal involvement, for a
total of 58 surgeries. All 56 patients presented with pain. After surgery,
significant relief was noted by 51 (91%). Twenty-seven patients presented
with neurologic compromise. After operation, neurologic improvement was
noted in 20 (74%). No patient's neurologic function deteriorated secondary
to surgical intervention. Twenty-one patients were bedridden before surgery
secondary to pain or paresis. After operation, improvement in activity level
was achieved in 16 (76%) of these patients. In summary, the goal of surgical
treatment of metastatic spine disease is to improve the quality of the
remaining life, by the relief of pain and preservation or restoration of
neurologic function. The dismal consequences of prolonged bed rest,
paraplegia, and a painful premature demise can be avoided with thoughtful
and timely surgical intervention.

Orthopedics 1992 May;15(5):611-20
Metastatic disease of the spine.
O'Connor MI, Currier BL
Department of Orthopedic Surgery, Mayo Clinic Jacksonville, Fla.
Advances in imaging studies and techniques of spinal stabilization permit
improved surgical treatment of patients with metastatic disease of the
spine. Preoperative evaluation, selection of patients for operative
management, and results of published clinical series are reviewed. Surgical
approaches for optimal tumor excision, neural decompression, and spinal
stabilization are discussed.

AJNR Am J Neuroradiol 1993 Sep-Oct;14(5):1113-7
Percutaneous injection of an alcoholic embolizing emulsion as an alternative
preoperative embolization for spine tumor.
Chiras J, Cognard C, Rose M, Dessauge C, Martin N, Pierot L, Plouin PF
Hopital Pitie-Salpetriere, Paris, France.
A hypervascular pheochromocytoma metastasis in the sixth cervical vertebra
was embolized preoperatively by an intravertebral injection of an alcoholic
embolizing emulsion, when transarterial embolization was considered too
dangerous because of the possibility of inadvertent embolization of the
intracerebral vertebrobasilar territory.

Arch Orthop Trauma Surg 1997;116(5):279-82
Use of preoperative vascular embolisation in spinal metastasis resection.
Hess T, Kramann B, Schmidt E, Rupp S
Orthopadische Universitats und Poliklinik, Homburg, Germany.
Preoperative selective embolisation was carried out on 17 patients with
spinal metastases from various primary tumours. There was a significant
reduction in the blood loss (2088 ml) and infusion volume requirement (3500
ml) and more favourable postoperative haemoglobin (Hb) development compared
with the non-embolised but otherwise identical control group. The reduced
intraoperative bleeding manifested itself in the form of greater clarity and
a less complicated intraoperative course. Particularly with a dorsal
approach, the reduced bleeding permitted more exact preparation and more
extensive tumour resection. Preoperative embolisation is thus a valuable aid
in spinal metastasis resection. Given suitable indications and exact
positioning of the embolising material, no significant complications should
arise. The method as a whole calls for close collaboration between
interventional radiologists and spinal orthopaedists.

Cardiovasc Intervent Radiol 1989 Sep-Oct;12(5):252-4
Embolization of paraspinal masses.
Coldwell DM
Department of Radiology, University of Washington, School of Medicine,
Seattle.
Arterial embolization is a method of palliative therapy for both primary and
metastatic tumors. This treatment is frequently used in the liver and
kidney, but has not been previously extended to paraspinal masses. Five
patients with recurrent renal cell carcinoma or neurofibrosarcoma underwent
palliative embolization for pain or mass effect. All had relief of pain
after embolization. Four patients showed change in the mass on follow-up
computed tomography scan with one demonstrating tumor shrinkage. Arterial
embolization can be an effective method for palliation of pain and mass
effect caused by paraspinal masses.

Neurosurgery 1990 Nov;27(5):755-9
Preoperative superselective arteriolar embolization: a new approach to
enhance resectability of spinal tumors.
Broaddus WC, Grady MS, Delashaw JB Jr, Ferguson RD, Jane JA
Department of Neurological Surgery, University of Virginia Health Sciences
Center, Charlottesville.
The extent of surgical resection of spinal tumors is frequently limited by
blood loss and technical difficulty associated with the vascularity of the
tumors. We report here the use of superselective percutaneous arterial
embolization to reduce the rate of blood loss at the time of surgical
resection and enhance resectability. The types of tumors treated were
metastatic renal carcinoma, metastatic thyroid carcinoma, metastatic
melanoma, and giant cell tumor of the sacrum. Two of the patients required
repeated embolization and surgery for recurrent symptoms. The estimated
blood loss in seven of nine procedures performed on the six patients ranged
from 300 to 800 ml, after which no transfusion was required. In two
procedures, extensive resection of very large tumors resulted in larger
losses of blood, and postoperative transfusion was necessary. No significant
complications of embolization or surgery occurred. A key factor in our
embolization technique is the use of microfibrillar collagen, which allows
occlusion of tumor vessels as small as 20 microns and may prevent
reconstitution of the embolized vessels by collateral flow. We conclude that
preoperative arterial embolization enhances the resectability of a variety
of spinal tumors by reducing intraoperative blood loss. This may provide an
additional benefit by reducing the risk related to postoperative
transfusion. By permitting a more aggressive surgical approach, the use of
preoperative embolization also has the potential to improve outcome in
patients with spinal tumors.

Rev Chir Orthop Reparatrice Appar Mot 1992;78(7):480-4
[Preoperative embolization of cervical bone metastasis with radio-controlled
direct puncture].
[Article in French]
Herbreteau D, Guichard JP, Reizine D, Aymard A, Levy C, Augereau B, Merland
JJ
Service de Neuroradiologie Interventionnelle, Hopital Lariboisiere, Paris.
Surgery of vertebral hypervascular metastasis can take advantage of
preoperative embolization to make the surgical procedure easier to perform.
Usually, embolizations are executed by vascular tract. We report a case of
one cervical metastasis located in C4 for which embolization was executed
with direct puncture of the vertebra. This method has the advantage to be
feasible whatever tumoral vascularization, and more particularly in case of
departure of radiculo-medullary artery or any other cephalic vessel from the
tumoral site.

J Vasc Interv Radiol 1995 Nov-Dec;6(6):871-5
Preoperative embolization of spinal tumors.
Breslau J, Eskridge JM
Department of Radiology, University of Washington School of Medicine,
Seattle, USA.
PURPOSE: The authors retrospectively reviewed their 6-year clinical
experience with preoperative embolization of hypervascular tumors of the
spine. PATIENTS AND METHODS: Fourteen patients ranging in age from 16 to 70
years underwent a total of 17 embolization procedures (one patient underwent
four procedures) with polyvinyl alcohol particles. The lesions were located
from the lower cervical to upper lumbar spine. The primary symptom at
patient presentation was back pain, although several patients had lower
extremity weakness. Seven of 14 patients had metastatic lesions from renal
cell carcinoma. The remaining seven had a variety of hypervascular lesions.
RESULTS: Embolization was technically successful in all patients. No
complications were attributable to the angiography or embolization
procedures. Median estimated blood loss during surgical resection was 1.6 L.
In one patient, embolization resulted in relief of back pain, allowing
surgery to be postponed for 1 month. In two patients, embolization was
performed after previous surgery that was unsuccessful due to excessive
blood loss. These vertebral lesions were subsequently removed without
complication. CONCLUSIONS: Embolization of vertebral metastases is a safe
treatment prior to surgical resection. With appropriate monitoring,
complications can be eliminated. The resulting devascularization allows for
an aggressive resection of pathologic tissue.

Z Orthop 1989 Jul-Aug;127(4):410-3
[Surgical treatment of primary and secondary malignant tumors of the
thoracic and lumbar spine].
[Article in German]
Gradinger R, Opitz G, von Gumppenberg S, Gobel WE, Hipp E
Orthop. Klinik der TU Munchen.
After considering conservative therapeutic measures, the authors opt for
surgical treatment of primary or secondary spinal tumors if neurologic
deficits occur or the structural stability of the spine is at risk. The
majority of the tumors are located in the ventral section of the spine,
i.e., in the vertebral body, and therefore the present authors mainly
perform ventral tumor resection and spinal reconstruction (traction implant
plus bone cement and ventral traction bracing with the DKS system). In cases
with tumor spread over several segments and/or lumbosacral involvement the
authors recommend combined ventral and dorsal procedures in order to achieve
adequate stability of the vertebral body prosthesis.

Cardiovasc Intervent Radiol 1997 Sep-Oct;20(5):343-7
Preoperative embolization of cervical spine tumors.
Vetter SC, Strecker EP, Ackermann LW, Harms J
Department of Radiology and Nuclear Medicine, Diakonissenkrankenhaus,
Diakonissenstrasse 28, D-76199 Karlsruhe, Germany.
PURPOSE: To assess the technical success rate, complications, and effect on
intraoperative blood loss of preoperative transarterial embolization of
cervical spine tumors. METHODS: A retrospective analysis was performed on 
38 patients with tumors of the cervical spine; 69 vertebrae were affected.
Polyvinyl alcohol particles, coils, gelfoam particles, either alone or in
combination, were used for preoperative tumor embolization. After
embolization a total of 57 corporectomies with titanium basket implantation
were performed. RESULTS: In 36 of 38 patients, complete (n = 27) or partial
(n = 9) embolization was achieved. In 23 patients one vertebral artery was
completely occluded by coil placement, and in one patient the ipsilateral
internal and external carotid arteries were occluded in addition. No
neurological complications could be directly related to the embolization,
but two postoperative brain stem infarctions occurred. The mean
intraoperative blood loss was 2.4 L. CONCLUSION: Transarterial embolization
of cervical spine tumors is a safe and effective procedure to facilitate
extensive surgery.

J Vasc Interv Radiol 1995 Nov-Dec;6(6):863-9
Preoperative transarterial embolization of spinal column neoplasms.
Smith TP, Gray L, Weinstein JN, Richardson WJ, Payne CS
Department of Radiology, Duke University Medical Center, Durham, NC 27710,
USA.
PURPOSE: To determine the safety and value of vertebral column embolization
before surgical resection of vascular neoplastic disease. PATIENTS AND
METHODS: Thirty preoperative embolization procedures were performed in 20
patients with vascular neoplasms of the vertebral column (C-2 to sacrum).
Fourteen patients had metastatic renal cell carcinoma. Distal embolic agents
were used in 27 cases and were coupled with more proximal agents in six.
Gelatin pledgets alone were used in three cases. Twenty-six of the 27
surgical procedures involved partial to complete tumor resection. RESULTS:
Seventy-two arteries were embolized (one to six per procedure). All surgical
procedures were successful, and none were terminated because of blood loss.
Massive blood loss occurred in one patient with paraganglioma, but
embolization allowed complete vertebral resection at two levels. When this
patient was excluded, blood loss ranged from 300 to 5,000 mL (mean, 1,871
mL). Transfusions required in 22 surgical procedures ranged from 1 to 10
units of packed red blood cells. Symptoms became worse after embolization in
one case but improved with surgical decompression. CONCLUSION: Embolization
before surgery for spinal column neoplasms appears to safely and effectively
limit blood loss.

Spine 1991 Mar;16(3):265-71
Surgical management of metastatic renal carcinoma of the spine.
King GJ, Kostuik JP, McBroom RJ, Richardson W
Department of Orthopaedic Surgery, Toronto General Hospital, University of
Toronto, Ontario.
A total of 33 patients with renal cell carcinoma metastatic to the spine
underwent spinal decompression over a 5-year period; 20 were operated on for
neurologic dysfunction, and the remainder for pain alone. Surgery was
performed anteriorly in 21, posteriorly in 9, and combined in 3 cases. The
surgical approach was determined by the preoperative anatomic localization
of the tumor. Of these patients 88% had fusions with instrumentation and
polymethylmethacrylate; 88% of patients had partial or complete relief of
pain; and 64% of bedridden patients subsequently were able to walk.
Neurologic function improved in 60% of patients with a neurologic deficit;
however, only 36% of incontinent patients regained bladder control. Survival
averaged 8.0 +/- 1.5 months. Survival correlated with the degree of
neurologic dysfunction and the presence of other known metastases. Recurrent
cord compression developed in 49% of patients, usually at the same level; 9
of these 16 patients had repeat decompression, with similar operative
results as the primary procedure in terms of pain and neurologic function.
Blood loss was variable but often significant. Preoperative embolization
appeared to be beneficial. Precise tumor localization preoperatively
directing the surgical approach and better patient selection would likely
improve results and decrease morbidity. Good palliation appeared to be
achieved in regards to both pain relief and improved neurologic function.

Rev Rhum Mal Osteoartic 1991 Apr;58(3 ( Pt 2)):5S-10S
[Embolization of metastases of the mobile spine].
[Article in French]
Meder JF, Fredy D
Service de Neuroradiologie, CH Sainte-Anne, Paris.

J Neurosurg 1998 May;88(5):923-4
Tumor devascularization by intratumoral ethanol injection during surgery.
Technical note.
Lonser RR, Heiss JD, Oldfield EH
Surgical Neurology Branch, National Institute of Neurological Disorders and
Stroke, National Institutes of Health, Bethesda, Maryland 20892-1414, USA.
Preoperative reduction in tumor vascularity has been accomplished previously
by selective catheterization of tumor vessels and delivery of occlusive
materials. The results of percutaneous infusion of vertebral hemangiomas and
other vascular lesions led the authors to speculate that rapid
devascularization of tumors by direct injection of ethanol (ETOH) could be
used to reduce bleeding and facilitate resection during surgery. Thus, the
use of intratumoral injection of ETOH and its effects on tumor hemostasis
and resectability were examined. Four patients received direct injection of
ETOH into either a spinal epidural (two renal cell carcinomas and one
rhabdomyosarcoma) or a large cerebellar neoplasm (hemangioblastoma).
Intraoperative perfusion of the tumors with ETOH produced immediate
blanching and devascularization and enhanced visualization and resection.
Incremental tumor devascularization is achieved by careful injection of
small amounts of ETOH directly into the lesion, producing immediate and
complete regional tumor devascularization. Use of this technique reduces
intratumoral bleeding and enhances the ease and effectiveness of resection.

Radiology 1990 Sep;176(3):683-6
Vascular metastatic lesions of the spine: preoperative embolization.
Gellad FE, Sadato N, Numaguchi Y, Levine AM
Department of Radiology, University of Maryland Medical System, Baltimore
21201.
Preoperative embolization of vascular metastatic tumors of the spine,
particularly carcinomas of renal and thyroid origin, is an adjuvant
technique that significantly decreases the intraoperative blood loss and
resultant surgical morbidity. Surgical decompression was achieved in 24
spinal vascular metastatic lesions, 20 of which were treated with
preoperative embolization and four of which were not. The embolic materials
used were gelatin sponge, polyvinyl alcohol foams, and metallic coils. In
patients who underwent adequate embolization, an average of 1,850 mL of
estimated blood loss was reported; in those who underwent inadequate or no
embolization, greater than 3,500 mL of estimated blood loss occurred. When
gelatin sponge is used, surgery should be performed within 24 hours to
prevent preoperative recanalization.

J Vasc Interv Radiol 1993 Sep-Oct;4(5):681-5
Transarterial embolization of vertebral hemangioma.
Smith TP, Koci T, Mehringer CM, Tsai FY, Fraser KW, Dowd CF, Higashida RT,
Halbach VV, Hieshima GB
Department of Radiology, University of California San Francisco.
PURPOSE: The authors retrospectively reviewed their 4-year clinical
experience to determine the role of transarterial embolization in the
treatment of symptomatic vertebral hemangioma. PATIENTS AND METHODS: Eight patients (age range, 12-56 years) underwent a total of 10 embolization procedures; one patient underwent three procedures. 
The lesions were located between T-5 and L-5, and all patients presented with pain and symptoms referable to the lower extremities. 
RESULTS: Embolization was technically successful in all patients, and no complications were encountered. Six of eight patients underwent surgery within 48 hours of embolization; four of the six showed significant clinical improvement immediately after surgery and on follow-up (average, 34 months). 
Two patients did not improve postoperatively. 
Two patients initially underwent embolization as the sole
therapy. The first refused surgery and did not improve clinically; the
second underwent two embolization procedures without clinical improvement
and eventually underwent a third followed by surgery, which resulted in
clinical improvement. All patients were hemodynamically stable during
surgery, and blood loss was not problematic in any patient. CONCLUSIONS:
Overall, surgery was an effective treatment for symptomatic vertebral
hemangioma and the authors conclude that transarterial embolization of
vertebral hemangioma is a safe and efficacious adjunctive procedure to such
surgery. However, embolization was not as promising as a sole therapeutic
modality in this small group of patients.

Spine 1989 Jan;14(1):41-7
Surgical treatment of metastatic tumors of the spine.
Manabe S, Tateishi A, Abe M, Ohno T
Department of Orthopaedic Surgery, Teikyo University School of Medicine,
Tokyo, Japan.
The goal of surgical treatment of metastatic spinal tumors is to maintain
neurologic functioning without pain for the duration of the life expectancy.
Of 28 patients in this series, 25 who had metastasis in the vertebral body
underwent direct decompression by removal of the tumor, followed by
vertebral reconstruction. A combined anterior or posterior instrumentation
provided rigid spinal stability immediately after surgery. Three patients
with involvement of the posterior part of the vertebra were treated by
laminectomy for removal of the tumor, followed by posterior instrumentation.
As a result, of nine patients who are alive with improved neurologic
functions, seven have been ambulatory for an average duration of 13 months.
Of 19 patients who have already died, recurrence of neurologic deficits was
observed in five (26%), and 14 had no neurologic deterioration until they
succumbed to the malignancy. Removal of the tumor and reconstructive surgery
may be expected to produce satisfactory results.

J Urol 1977 Mar;117(3):378-80
Therapeutic embolization of symptomatic secondary renal tumors.
Nieh PT, Waltman AC, Althausen AF
A patient with colic and hematuria from renal involvement with osteogenic
sarcoma who was palliated by percutaneous arterial embolization is
described. While there has been much experience with embolization of primary
renal tumors, this represents the first reported case of therapeutic
embolization of a secondary renal tumor. Embolization is recommended as an
adjunct to chemotherapy in the poor-risk patient with a symptomatic
secondary renal tumor.

Orthopade 1998 May;27(5):269-73
[Interventional therapy of primary and secondary tumors of the spine].
[Article in German]
Brado M, Hansmann HJ, Richter GM, Kauffmann GW
Abteilung Radiodiagnostik, Radiologischen Universitatsklinik Heidelberg.
Therapeutic interventions in the skeletal system are an essential part of
interventional radiology. Although in terms of figures these procedures are
applied less frequently, they are very effective. Percutaneous transarterial
embolization of a spinal tumor is well-established interventional treatment.
It is primary treatment for preoperative devascularization, but also for
palliation of pain and for reduction of tumor volume. As an alternative
access for embolization, direct percutaneous puncture of a vertebra is used.
A new and promising technique is vertebroplasty, the percutaneous injection
of acrylic surgical cement in destroyed vertebrae. The present paper
discusses indications, technique, results and complications of these
interventional therapeutic modalities in the treatment of primary and
secondary spinal tumors.

AJNR Am J Neuroradiol 1999 May;20(5):757-63
Hypervascular spinal tumors: influence of the embolization technique on
perioperative hemorrhage.
Berkefeld J, Scale D, Kirchner J, Heinrich T, Kollath J
Institute of Neuroradiology, Klinikum der Johann-Wolfgang-Goethe
Universitat, Frankfurt/Main, Germany.
BACKGROUND AND PURPOSE: Corporectomy is an effective treatment for vertebral metastases; however, massive perioperative hemorrhage is often associated with this procedure. 
We compared preoperative particle, particle-coil, and coil embolizations of hypervascular spinal tumors prior to vertebral body
replacement to determine which prevented perioperative hemorrhage most
effectively. METHODS: The vertebral tumors of 59 patients were embolized
prior to corporectomy. In 26 cases, only coils were used for the proximal
occlusion of feeding segmental arteries. Twenty-four patients received a
combination of polyvinyl alcohol (PVA) particles and coils, and nine tumors
were embolized with particles alone. We compared intraoperative blood loss
between the three groups and 10 other patients who did not undergo
embolization prior to corporectomy. RESULTS: Estimation of intraoperative
hemorrhage showed a median value of 4350 mL in patients without
embolization, 2650 mL in cases of coil embolization, 1850 mL in cases of
particle-coil embolization, and 1800 mL in cases of particle embolization.
The difference between unembolized patients and those who underwent coil
embolization was not statistically significant. Particle and particle-coil
embolizations showed very similar results, and reduced hemorrhage
significantly as compared to unembolized and proximal coil occlusion cases.
Residual bleeding came from the venous system and the neighborhood of the
embolized region. CONCLUSION: Particle embolization prior to corporectomy
can reduce perioperative hemorrhage. The additional benefit of proximal coil
occlusion of arterial feeders is questionable.

J Belge Radiol 1998 Oct;81(5):223-5
Arterial embolization of bone metastases: is it worthwhile?
Layalle I, Flandroy P, Trotteur G, Dondelinger RF
Department of Medical Imaging, University Hospital Sart Tilman, Liege,
Belgium.
Arterial embolization was performed in ten skeletal metastases occurring in
nine patients: eight patients presented with renal cell carcinoma and one
with bronchogenic carcinoma. Five metastatic lesions were located in the
spine, one in the pelvis, three in the proximal humerus and one in the
proximal femur. Selective arterial embolization was performed preoperatively
in seven cases and as a palliative treatment in three cases. The embolic
material used was polyvinyl alcohol particles, gelatin sponge and coils or a
combination of these. Arterial embolization was technically successful in
all patients achieving subtotal (> 90%) tumour devascularization in five
metastases and a 75% devascularization in the remaining five lesions. In
operative patients, median intra-operative volume of blood transfusion was
510 mL. Palliative embolization was followed by major pain relief in two
cases and moderate relief in one case lasting from 7 to 26 months. Arterial
embolization is an effective and safe adjunctive treatment of hypervascular
bone metastases.