Treatment Considerations: Endovascular Osmotic Embolization
With routine embolizing agents, such as PVA or Embospheres™, as well as liquid agents, such as Onyx™ and Truefill™, immediate post-embolization cytotoxic and vasogenic edema or hemorrhage occur frequently and can cause spinal cord damage. Additionally, inadvertent embolization of adjacent feeding collaterals to the spinal cord with particles or solidifying liquid agents is problematic. Additionally, a complete devascularization with routine embolization agents is often difficult in hypervascular tumors due to incomplete penetration. Chemotherapeutic and radioactive embolic agents partly address the heterogeneous penetration problem of the particles or liquid emboli but would not be useful to devascularize the tumor acutely.
Osmotic embolization was pioneered to overcome the technical limitations of other embolization agents. It can be used for palliative, adjunct, and definitive treatment of tumors. Its major advantage is deep penetration into the vascular territories and tissue death by terminal dehydration with subsequent shrinkage. It is painful and monitored anesthesia care or general anesthesia is required.