Embolisation of Head, Neck and Spinal Tumours

Author: Dr Winston Chong*

What are the prerequisites for having embolisation of head, neck and spinal tumours?

Full blood examination and clotting profile (INR & APPT) are required for all patients. Thyroid function testing may be indicated and should be discussed with the radiologist. Pregnancy test should be performed in all women of reproductive age. Any relevant previous imaging tests should be available at the time of the first consultation. As a minimum there should be a recent MRI or CT. Other preliminary tests such as angiogram should be discussed with the interventional neuroradiologist.

The patient should have a preliminary consent discussion with the referring doctor (if the referrer is also the treating surgeon) regarding the condition in general and all of the treatment options. If the referrer is not the treating surgeon, then the patient should be referred to one.

A letter or request for the embolisation procedure is required by the radiologist. Relevant clinical details of the patient including pre-existing significant medical and surgical conditions should be provided to the interventional neuroradiologist.

The treating surgeon and the interventional neuroradiologist need to discuss the case before an appointment for embolisation can be made.

Patients taking warfarin should be converted to heparin prior to the procedure. Heparin needs to be ceased for 24 hours prior to the procedure.

What are the absolute contraindications for embolisation of head, neck and spinal tumours?

Very large body habitus well beyond the weight limit of the angiographic table. This depends on the machine but generally from 120kg to 200kg. Consult with radiologist.

Large amounts of metallic hardware within the body area containing the tumour can totally obscure X-ray penetration and may make the procedure impossible.

Please consult with the radiologist regarding the above.

What are the relative contraindications for embolisation of head, neck and spinal tumours?

Relative or absolute contraindications to iodinated contrast.

Any severe blood bleeding disorders need to have temporary control of the abnormal clotting profile. Consult haematology.

What are the adverse effects of embolisation of head, neck and spinal tumours?

The risks and adverse effects include:

• Risks of General Anaesthetic.
• Rarely, there may be a retroperitoneal haematoma from the puncture site. However, the rate of puncture site haematoma requiring transfusion, surgery or delayed discharge is should be less than 3%.
• The risk directly related to the embolisation procedure itself depends on where the tumour is. The risk ranges from minimal to serious and can include cerebral ischaemia or infarction. However, the overall risk is very small, usually less than 1% to 2% chance of a major stroke.

Are there alternative imaging tests, interventions or surgical procedures to embolisation of head, neck and spinal tumours?

Open surgery without embolisation.

*The author has no conflict of interest with this topic.

Page last modified on 26/7/2017.