Onyx injection by direct puncture for presurgical embolization of a C2 hypervascular metastasis from a thyroid cancer

Frédéric Clarençon (1) , Pierre-Emmanuel Moreau (1) , Jonathan Cortese (2) , Gauthier Eloy (1) , Frédéric Deschamps (3, 4) , Eimad Shotar (1) , Kevin Premat (1) , Evelyne Cormier (1) , Raphaël Bonaccorsi (1)

1 CHU Pitié-Salpêtrière [AP-HP]
2 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
3 IGR - Institut Gustave Roussy
4 Imagerie thérapeutique (radiologie interventionnelle)

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

Mots clés: cervical; liquid embolic material; spine; tumor

Domaines: Cancer; Endocrinologie et métabolisme; Chirurgie

Frédéric Clarençon, Pierre-Emmanuel Moreau, Jonathan Cortese, Gauthier Eloy, Frédéric Deschamps, et al.. Onyx injection by direct puncture for presurgical embolization of a C2 hypervascular metastasis from a thyroid cancer. Journal of Neurointerventional Surgery, In press, ⟨10.1136/neurintsurg-2020-017180⟩. ⟨hal-03185172⟩