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Technical video
Onyx injection by direct puncture for presurgical embolization of a C2 hypervascular metastasis from a thyroid cancer
  1. Frédéric Clarençon1,
  2. Pierre-Emmanuel Moreau2,
  3. Jonathan Cortese3,
  4. Gauthier Eloy2,
  5. Frédéric Deschamps4,
  6. Eimad Shotar5,
  7. Kevin Premat1,
  8. Evelyne Cormier5,
  9. Raphaël Bonaccorsi2
  1. 1 Neuroradiology, Sorbonne University - Pitié-Salpêtrière Hospital, Paris, Île-de-France, France
  2. 2 Orthopedic Surgery, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
  3. 3 NEURI-Neurointerventional Radiology, Hopital Bicetre, Le Kremlin-Bicetre, France
  4. 4 Interventional Radiology, Institut Gustave-Roussy, Villejuif, Île-de-France, France
  5. 5 Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
  1. Correspondence to Professor Frédéric Clarençon, Neuroradiology, University Hospital Pitié Salpêtrière, Paris 75013, Île-de-France, France; fredclare5{at}gmail.com

Abstract

Surgery for spinal hypervascular lesions, such as hemangioma or metastases from thyroid or renal cancer, may be challenging because of the risk of massive blood loss.1 To overcome this limitation, presurgical embolization has gained acceptance to reduce this risk.2 However, some configurations, such as the origin of a radiculomedullary artery close to the vessels feeding the lesion or when the lesion is supplied by vessels feeding an eloquent territory, may limit the possibility of presurgical embolization, especially with microparticles.3 Direct percutaneous puncture of the spinal lesion and subsequent embolization with liquid embolic agent may be a valuable option in such challenging cases.4

We present a case of presurgical embolization of a C2 metastasis from a thyroid cancer using Onyx-18 injected by direct puncture (video 1). In this technical video, we stress the technical aspects of the direct puncture technique and the safety rules to avoid neurological complications.

Video 1
  • cervical
  • liquid embolic material
  • spine
  • tumor

https://doi.org/10.1136/neurintsurg-2020-017180

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    Footnotes

    • Contributors FC: manuscript redaction and video preparation. P-EM, GE, ES, KP, EC, and RB: critical review of the manuscript. JC and FD: data acquisition and critical review of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests FC reports conflicts of interest with Medtronic, Guerbet, Balt Extrusion, Penumbra (payment for readings; not related to the study), Codman Neurovascular, and Microvention (core lab; not related to the study).

    • Provenance and peer review Not commissioned; externally peer reviewed.