PT  - JOURNAL ARTICLE
AU  - Frédéric Clarençon
AU  - Pierre-Emmanuel Moreau
AU  - Jonathan Cortese
AU  - Gauthier Eloy
AU  - Frédéric Deschamps
AU  - Eimad Shotar
AU  - Kevin Premat
AU  - Evelyne Cormier
AU  - Raphaël Bonaccorsi
TI  - Onyx injection by direct puncture for presurgical embolization of a C2 hypervascular metastasis from a thyroid cancer
AID  - 10.1136/neurintsurg-2020-017180
DP  - 2021 Mar 19
TA  - Journal of NeuroInterventional Surgery
PG  - neurintsurg-2020-017180
4099  - http://jnis.bmj.com/content/early/2021/03/23/neurintsurg-2020-017180.short
4100  - http://jnis.bmj.com/content/early/2021/03/23/neurintsurg-2020-017180.full
AB  - 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.4We 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