Preoperative embolisation of renal cell carcinoma metastases to the spine - evaluation of procedural and clinical outcome.

Purpose: Renal cell carcinoma (RCC) is the fourth most common metastatic tumour of the spine. RCC metastases are highly vascular and might cause life-threatening intraoperative bleeding. That is why preoperative embolisation is performed to reduce intraoperative blood loss. The aim of this study was to evaluate the procedural and clinical outcomes of preoperative embolisation of RCC metastases to the vertebral column. Material and methods: In this single-centre retrospective study, data of 59 consecutive patients undergoing endovascular treatment prior to surgical resection were collected and evaluated. In all cases superselective catheterisation and occlusion of feeding vessels was attempted and performed if deemed safe and possible. Completeness of embolisation, procedural details, and the complication rate were evaluated. Surgical procedures were carried out within 48 hours after embolisation. The surgical approach was dependent on the anatomical site and osseous destruction. Intraoperative blood loss was estimated. Results: Fifty-nine patients with a mean age of 63 years were included. Complete embolisation was successful in 76% (45/59) and partial in 15% (9/59). Microspheres were the most commonly used embolic material. In 5 cases (8%) safe occlusion was not possible due to the radiculomedullary artery originating from the same pedicle as the tumour. Minor complications (vomiting, increased pain) occurred in 8 patients. Paraplegia (one transient and one permanent) was noted in 2 cases. Estimated intraoperative blood loss was 830 ± 410 ml. Conclusions: The results of our study show that preoperative embolisation is a feasible and effective method with a relatively high rate of occlusion and low complication rate.

Evaluation of the survivability of femoral shaft reconstructions after resection of tumor and tumor-like lesions.

Background. The reconstruction of femoral shaft defects after tumor resection involves joining healthy bone fragments with plates or intramedullary rods, using methyl metacrylate cement or bone grafts. Material and methods. 50 patients (35 females and 15 males) were operated over the last 24 years. The patients' ages ranged from 12 to 80 years (mean 56). Results. There were 37 bone metastases, 11 primary neoplasms, 1 eosiniphilic granuloma and 1 solitary bone cyst. Plates were used for reconstruction in 17 cases, and intramedullary rods in 31 cases. Long intramedullary fibula grafts were used to stabilize bone fragments in 2 patients with benign lesions. The post-resection defect was filled with methyl metacrylate cement in 47 cases, and with bone chips in 3 cases. One patient died shortly after surgery, 5 were nonambulatory because of diffusion of neoplastic changes. There were 4 deep infections and 4 tumor recurrences in other patients. Mechanical failures occurred in 10 patients from 2 to 30 months postoperatively because of methyl metacrylate loosening. Conclusions. Bone-cement union is the decisive factor in stabilizing fragments after a tumor has been resected from the femoral shaft and the defect filled with cement. The defect filling after resection of a segment of the femur is only stable for a short time; later, there is loosening and the resultant fracture of the rod. Bone cement should be used to fill the defect in patients treated for metastases to bone, but not in patients with a primary bone tumor. Plates should not be used to join the fragment of the femur.