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DOI: 10.1055/s-0034-1394191
Comparing Angiographic Devascularization with Histologic Penetration after Preoperative Tumor Embolization with Onyx: What Indicates an Effective Procedure?
Publication History
11 October 2013
26 June 2014
Publication Date:
16 January 2015 (online)
![](https://www.thieme-connect.de/media/jnlsa/201504/lookinside/thumbnails/10-1055-s-0034-1394191_131028oa-1.jpg)
Abstract
Background and Purpose To assess Onyx (Covidien, Irvine, California, United States) efficacy as a preoperative embolic agent for neoplasms of the head, neck, and spine, and to compare angiographic and histologic evidence of tumor penetration as predictors of intraoperative blood loss.
Materials and Methods Retrospective analysis of preoperative Onyx embolization procedures for treatment of head, neck, and spine tumors from 2009 to 2011. Patient demographics and information relating to the embolization procedure and operation were recorded. Measures of Onyx efficacy included intraoperative blood loss and length of surgery. Angiographic and histologic penetration, in addition to percentage of tumor devascularization, were assessed as predictors of efficacy.
Results A total of 22 patients with 17 head or neck and 5 spinal lesions underwent trans-arterial preoperative Onyx embolization. Good angiographic penetration was reported in 41% of tumors and central histologic penetration in 59%, with mean tumor devascularization of 85.3% (standard deviation [SD]: 12.6%). There was no relationship between angiographic and histologic Onyx penetrance. Mean surgical blood loss was 1342 mL (SD: 1327 mL), and length of surgery was 289 minutes (SD: 162 minutes). Neither angiographic, nor histologic Onyx penetration predicted intraoperative blood loss (p = 0.38 and p = 0.32, respectively) or surgical length (p = 0.62 and 0.90, respectively). Devascularization was not associated with blood loss (p = 0.62), but it was a negative predictor of surgical length (p = 0.013).
Conclusions Preoperative Onyx embolization of head, neck, and spine tumors is capable of deep histologic tumor penetration, even when not visualized on angiography. The lack of association between measures of procedural adequacy suggests that using angiographic devascularization as a measure of procedural efficacy may be of limited utility.
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References
- 1 Ayad M, Eskioglu E, Mericle RA. Onyx: a unique neuroembolic agent. Expert Rev Med Devices 2006; 3 (6) 705-715
- 2 Gore P, Theodore N, Brasiliense L , et al. The utility of onyx for preoperative embolization of cranial and spinal tumors. Neurosurgery 2008; 62 (6) 1204-1211 ; discussion 1211–1212
- 3 Gobin YP, Murayama Y, Milanese K , et al. Head and neck hypervascular lesions: embolization with ethylene vinyl alcohol copolymer—laboratory evaluation in swine and clinical evaluation in humans. Radiology 2001; 221 (2) 309-317
- 4 Quadros RS, Gallas S, Delcourt C, Dehoux E, Scherperel B, Pierot L. Preoperative embolization of a cervicodorsal paraganglioma by direct percutaneous injection of Onyx and endovascular delivery of particles. AJNR Am J Neuroradiol 2006; 27 (9) 1907-1909
- 5 Rimbot A, Mounayer C, Loureiro C , et al. Preoperative mixed embolization of a paraganglioma using Onyx [in French]. J Neuroradiol 2007; 34 (5) 334-339
- 6 Hu YC, Newman CB, Porter RW, Albuquerque FC. Transarterial Onyx embolization of sacral chordoma: case report and review of the literature. J Neurointerv Surg 2011; 3 (1) 85-87
- 7 Tampieri D, Leblanc R, TerBrugge K. Preoperative embolization of brain and spinal hemangioblastomas. Neurosurgery 1993; 33 (3) 502-505 ; discussion 505
- 8 Seong Eom K, Won Kim D, Sung Choi S, Ha Choi K, Young Kim T. Preoperative embolization of a cerebellar haemangioblastoma using Onyx: case report and literature review. Neurol Neurochir Pol 2011; 45 (3) 292-296
- 9 Olerud C, Jónsson Jr H, Löfberg AM, Lörelius LE, Sjöström L. Embolization of spinal metastases reduces perioperative blood loss. 21 patients operated on for renal cell carcinoma. Acta Orthop Scand 1993; 64 (1) 9-12
- 10 Gemmete JJ, Chaudhary N, Pandey A , et al. Usefulness of percutaneously injected ethylene-vinyl alcohol copolymer in conjunction with standard endovascular embolization techniques for preoperative devascularization of hypervascular head and neck tumors: technique, initial experience, and correlation with surgical observations. AJNR Am J Neuroradiol 2010; 31 (5) 961-966
- 11 Arat A, Cil BE, Vargel I , et al. Embolization of high-flow craniofacial vascular malformations with Onyx. AJNR Am J Neuroradiol 2007; 28 (7) 1409-1414
- 12 Hurley MC, Gross BA, Surdell D , et al. Preoperative Onyx embolization of aggressive vertebral hemangiomas. AJNR Am J Neuroradiol 2008; 29 (6) 1095-1097
- 13 Gemmete JJ, Patel S, Pandey AS , et al. Preliminary experience with the percutaneous embolization of juvenile angiofibromas using only ethylene-vinyl alcohol copolymer (Onyx) for preoperative devascularization prior to surgical resection. AJNR Am J Neuroradiol 2012; 33 (9) 1669-1675
- 14 Shah HM, Gemmete JJ, Chaudhary N, Pandey AS, Ansari SA. Preliminary experience with the percutaneous embolization of paragangliomas at the carotid bifurcation using only ethylene vinyl alcohol copolymer (EVOH) Onyx. J Neurointerv Surg 2012; 4 (2) 125-129
- 15 Elhammady MS, Wolfe SQ, Ashour R , et al. Safety and efficacy of vascular tumor embolization using Onyx: is angiographic devascularization sufficient?. J Neurosurg 2010; 112 (5) 1039-1045
- 16 Tasar M, Yetiser S. Glomus tumors: therapeutic role of selective embolization. J Craniofac Surg 2004; 15 (3) 497-505
- 17 White JB, Link MJ, Cloft HJ. Endovascular embolization of paragangliomas: a safe adjuvant to treatment. J Vasc Interv Neurol 2008; 1 (2) 37-41
- 18 Rangel-Castilla L, Shah AH, Klucznik RP, Diaz OM. Preoperative Onyx embolization of hypervascular head, neck, and spinal tumors. Experience with 100 consecutive cases from a single tertiary center. J Neurointerv Surg 2012; 6 (1) 51-56
- 19 Duffis EJ, Gandhi CD, Prestigiacomo CJ , et al; Society for Neurointerventional Surgery. Head, neck, and brain tumor embolization guidelines. J Neurointerv Surg 2012; 4 (4) 251-255
- 20 Komemushi A, Tanigawa N, Okuda Y , et al. A new liquid embolic material for liver tumors. Acta Radiol 2002; 43 (2) 186-191
- 21 Dawbarn RM. The starvation operation for malignancy in the external carotid area. JAMA 1904; 43 (12) 792-795
- 22 Serbinenko FA. Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 1974; 41 (2) 125-145
- 23 Gupta R, Thomas AJ, Horowitz M. Intracranial head and neck tumors: endovascular considerations, present and future. Neurosurgery 2006; 59 (5) (Suppl. 03) S251-S260 ; discussion S3–S13
- 24 Manelfe C, Guiraud B, David J , et al. Embolization by catheterization of intracranial meningiomas [in French]. Rev Neurol (Paris) 1973; 128 (5) 339-351
- 25 Dean BL, Flom RA, Wallace RC , et al. Efficacy of endovascular treatment of meningiomas: evaluation with matched samples. AJNR Am J Neuroradiol 1994; 15 (9) 1675-1680
- 26 Deshmukh VR, Fiorella DJ, McDougall CG, Spetzler RF, Albuquerque FC. Preoperative embolization of central nervous system tumors. Neurosurg Clin N Am 2005; 16 (2) 411-432 , xi
- 27 Gruber A, Bavinzski G, Killer M, Richling B. Preoperative embolization of hypervascular skull base tumors. Minim Invasive Neurosurg 2000; 43 (2) 62-71
- 28 Guzman R, Dubach-Schwizer S, Heini P , et al. Preoperative transarterial embolization of vertebral metastases. Eur Spine J 2005; 14 (3) 263-268
- 29 Kim LJ, Albuquerque FC, Aziz-Sultan A, Spetzler RF, McDougall CG. Low morbidity associated with use of n-butyl cyanoacrylate liquid adhesive for preoperative transarterial embolization of central nervous system tumors. Neurosurgery 2006; 59 (1) 98-104 ; discussion 98–104
- 30 Nelson PK, Setton A, Choi IS, Ransohoff J, Berenstein A. Current status of interventional neuroradiology in the management of meningiomas. Neurosurg Clin N Am 1994; 5 (2) 235-259
- 31 Oka H, Kurata A, Kawano N , et al. Preoperative superselective embolization of skull-base meningiomas: indications and limitations. J Neurooncol 1998; 40 (1) 67-71
- 32 Rosen CL, Ammerman JM, Sekhar LN, Bank WO. Outcome analysis of preoperative embolization in cranial base surgery. Acta Neurochir (Wien) 2002; 144 (11) 1157-1164
- 33 Loh Y, Duckwiler GR ; Onyx Trial Investigators. A prospective, multicenter, randomized trial of the Onyx liquid embolic system and N-butyl cyanoacrylate embolization of cerebral arteriovenous malformations. Clinical article. J Neurosurg 2010; 113 (4) 733-741
- 34 Natarajan SK, Born D, Ghodke B, Britz GW, Sekhar LN. Histopathological changes in brain arteriovenous malformations after embolization using Onyx or N-butyl cyanoacrylate. Laboratory investigation. J Neurosurg 2009; 111 (1) 105-113
- 35 Elhammady MS, Peterson EC, Johnson JN, Aziz-Sultan MA. Preoperative onyx embolization of vascular head and neck tumors by direct puncture. World Neurosurg 2012; 77 (5–6) 725-730
- 36 Herman B, Bublik M, Ruiz J, Younis R. Endoscopic embolization with onyx prior to resection of JNA: a new approach. Int J Pediatr Otorhinolaryngol 2011; 75 (1) 53-56
- 37 Aziz-Sultan MA, Moftakhar R, Wolfe SQ, Elhammady MS, Herman B, Farhat H. Endoscopically assisted intratumoral embolization of juvenile nasopharyngeal angiofibroma using Onyx. J Neurosurg Pediatr 2011; 7 (6) 600-603