Minimizing Intraoperative Blood Loss During Lumbar Vertebrectomy for Spinal Metastasis of Renal Neoplasm: Specific Radiological Embolization Technique.

BACKGROUND: Clear cell renal cell carcinoma is the most common malignant renal tumor, sometimes causing highly vascularized vertebral metastases. If the metastasis is isolated, en bloc resection of the lesion should be discussed. Vertebrectomy for curative oncologic purposes carries a significant risk of bleeding. We report a case in our center of a patient who underwent a special embolization technique prior to vertebrectomy, which significantly reduced intraoperative blood loss.

METHODS: We report a case of special embolization technique prior to vertebrectomy.

RESULTS: A 62-year-old patient, recently diagnosed with clear cell renal cell carcinoma, had an extension workup which found an isolated hypervascularized metastasis of the L3 vertebra. He underwent a preoperative embolization bilaterally and distally of the right and left vascular pedicles of the L3 vertebra under balloon inflation using the "pressure cooker" technique, which allowed diffuse tumor filling, followed by L3 vertebrectomy in a two-phase operation. Thanks to this specific technique, intraoperative blood loss was significantly reduced to 800 mL.

CONCLUSIONS: Lumbar vertebrectomy is a surgical technique with a high risk of hemorrhage in the context of highly vascularized spinal metastasis. Blood loss must be reduced by the surgeon's knowledge of lumbar vascular anatomy, the use of conventional hemostasis techniques, and rapid tumor resection. Preoperative embolization of the tumor's feeder vessels was performed bilaterally and distally, using simultaneous arterial catheterization of the right and left vertebral vascular pedicules, under balloon inflation using the "pressure cooker" technique, and it also significantly reduces intraoperative blood loss.