Preoperative Bone Tumor Embolization

Background and indications

Pre-operative bone tumor embolization consists of occluding feeding arteries of a hypervascular bone tumor before surgical resection to reduce intraoperative bleeding. It is mainly indicated for hypervascular bone metastases (renal, thyroid), hypervascular primary tumors (giant cell tumor, aggressive vertebral hemangioma, sarcoma), and certain vertebral tumors requiring extensive resection.

Pre-procedure assessment

Assessment includes tumor MRI, contrast-enhanced CT (tumor vascularity evaluation), and coordination with the surgical team on operative planning (embolization is ideally performed 24-72 hours before surgery).

Procedure

Under local anesthesia and sedation, a catheter is introduced through the femoral artery. Under fluoroscopic guidance, tumor feeding arteries are identified by arteriography and selectively catheterized. Embolization is performed with calibrated particles (PVA, microspheres) and/or coils. For vertebral tumors, particular attention is paid to radiculomedullary arteries (artery of Adamkiewicz) to prevent neurological complications. The procedure takes 1 to 2 hours.

Results and scientific evidence

Pre-operative embolization reduces intraoperative bleeding by 40-60% and operative time significantly. Blood transfusion is reduced or avoided in most cases. For vertebral renal metastases, benefit is particularly documented with > 80% devascularization in most cases (Barton et al., Spine, 2014).

Risks and complications

Local pain (20-30%), post-embolization syndrome (fever, malaise: 10-20%), non-target embolization with nerve ischemia (< 1%, mainly vertebral — main risk), skin necrosis (< 1%). Major neurological complications are rare with careful selective catheterization.

Recovery

1 night hospitalization. Surgery planned within 24-72 hours to benefit from maximum embolization effect.

Practical information

The procedure is performed as an inpatient, in close coordination with the surgical team.