Spinal Hemangioma Embolization Posterior Spinal Artery and Arms Up Down DYNA

Enlarging hemangioma, biopsy-proven, T8

Anything interesting?

Important to identify adjacent level spinal cord supply and possible adjacent level tumor supply

Adamkiewicz. Excellent venous phase imaging.

DYNAs of same to follow

Left T8 level. Can u see the PSA? Dont be fooled by the 2D appearance. Its a much bigger territory than meets the eye. Respect the PSA

DYNA of left T8 — Icono 7 sec single spin micro / unbinned. 1 cc/sec for 9 sec 2 sec delay. PSA is solid arrows. the left T7 radiculomedullary artery (dashed arrows) is opacified via longitudinal anastomoses. The main supply to the hemangioma is via the ventral epidural arcade (open arrow).

There are two problems with having PSA at left T8. If we dont embolize left T8, we leave some hemangioma behind. If we only embolize from the right, hoping its safe, the embolic material may well cross over via the well-formed ventral epidural arcade and end up in the PSA anyway.

What to do? That depends on how much we want to achieve. One approach is to say that the hemangioma is not embolizable. Another is to selectively catheterize the ventral epidural arcade and embolize/block it, thus allowing for safer embo of right T8. We of course prefer the latter option. The worst option is the middle road — just to embolize the right side. It has the least efficacy (since left supply will remain) and the most risk.

The ventral epidural arcade is selectively catheterized (headway duo / synchro 14 soft) and embolized with particles and detachable coil

The right side — intercostal artery is blocked with affordable and quick to deploy pushable fibercoils. The hemangioma is then embolized with PCA. The branch is left open in case future embo is needed again

Now we turn attention to ASA evaluation. Excellent DYNA depends on all details — having arms lifted up for example is much better. Same aquisition — ICONO, 7 sec DCT / single spin/ unbinned 22FOV micro. 1 cc/sec for 9 cc 2 sec delay arterial phase.

Even more difference in venous phase. 1 cc/sec for 8 cc 13 sec delay.

6D

Coronal Collage

Video