Preoperative tumor embolization via pedicle artery sacrifice for symptomatic spinal aneurysmal bone cysts: illustrative cases.

backgroundSpinal aneurysmal bone cysts (ABCs) are challenging to manage due to high vascularity and proximity to critical structures. Two patients with large, symptomatic thoracic ABCs are presented. OBSERVATIONS: Preoperative tumor embolization via pedicle artery sacrifice was performed prior to planned resection to reduce intraoperative blood loss and the risk of postoperative neurological deficits. Less intraoperative blood loss contributes to better surgical visualization and patient stability, thereby promoting maximal safe tumor resection with reduced neurological morbidity. Coil embolization was selected in both cases due to lower risks of nontarget embolization given local feeders to the anterior spinal artery. Provocative methohexital and lidocaine testing was performed with intraoperative monitoring to minimize risk prior to embolizing each vessel. LESSONS: The indications for preoperative embolization for spinal ABCs remain controversial. The risks associated with this embolization strategy, including those inherent to spinal angiography and embolization as well as increased costs, are potentially outweighed by the benefits of decreased intraoperative blood loss to maximize surgical safety and risks in select patients. In both cases, complete tumor resection was achieved, with the patients experiencing no adverse effects due to embolization, lower-than-expected intraoperative blood loss, and near-complete return of neurological function. https://thejns.org/doi/10.3171/CASE24580.