TY - JOUR T1 - Onyx injection by direct puncture for presurgical embolization of a C2 hypervascular metastasis from a thyroid cancer JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg DO - 10.1136/neurintsurg-2020-017180 SP - neurintsurg-2020-017180 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 Y1 - 2021/03/19 UR - http://jnis.bmj.com/content/early/2021/03/23/neurintsurg-2020-017180.abstract N2 - 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 ER -