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Abstract
A case of a 42-year-old man with back pain associated with left radiculopathy and infiltrative mass involving the T12 and L5 vertebrae is described. Magnetic resonance imaging (MRI) and computed tomography indicated aggressive hemangiomas involving the T12 and L5 vertebrae. Three-year follow-up by imaging indicated minimally increased aggressiveness of the L5 lesion without any significant change in appearance of the T12 lesion thus, confirming the initial diagnosis of multiple aggressive vertebral hemangiomas.
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Affiliation(s)
- Parag Suresh Mahajan
- Department of Clinical Imaging, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Vidya Chander Negi
- Department of Clinical Imaging, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
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102
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Slon V, Stein D, Cohen H, Sella-Tunis T, May H, Hershkovitz I. Vertebral hemangiomas: their demographical characteristics, location along the spine and position within the vertebral body. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:2189-95. [PMID: 25987455 DOI: 10.1007/s00586-015-4022-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 05/12/2015] [Accepted: 05/13/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Vertebral hemangiomas (VHs) are the most common form of benign tumors in the spine. The aim of this research was to study the prevalence of VHs in the human population, their distribution along the spine and their location in the vertebral body. METHODS The presence of VHs was assessed in full spine CT scans of 196 adults. Demographic data were gathered from medical records. RESULTS VHs were present in 26.0% of the individuals studied, a rate significantly higher (χ2=43.338, p<0.001) than the prevalence reported in the literature (10.7%). Multiple VHs (≥2) appeared in 7.2% of the population studied. VHs prevalence is sex-independent, appearing in 28.6% of females and 23.5% of males (χ2=0.663, p=0.416); and age-dependent: the mean age of affected individuals (65.8 years) was significantly higher (p<0.001) than unaffected individuals (56.2 years). VH size was also age-dependent (p=0.023). No vertebra was significantly more prone to be affected by a hemangioma. T11 and T12 show the highest prevalence of VHs (3.57% of vertebrae affected). VHs were found in similar percentages in the anterior and posterior parts of the vertebral body (52.8 vs. 47.2%, respectively); and at its center and periphery (50.1 and 49.9%, respectively). VHs usually appeared at mid-height of the vertebral body or slightly higher. CONCLUSIONS The reported prevalence of VHs is dependent on the demographic structure of the population studied, the size of the VHs and the method used to identify them. Overall, the phenomenon is more frequent than usually reported. VHs may appear at all vertebral levels and in all areas of the vertebral body.
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Affiliation(s)
- Viviane Slon
- Department of Anatomy and Anthropology, The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel
| | - Dan Stein
- Department of Anatomy and Anthropology, The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel
| | - Haim Cohen
- Department of Anatomy and Anthropology, The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel
| | - Tatiana Sella-Tunis
- Department of Anatomy and Anthropology, The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel.,The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel
| | - Hila May
- Department of Anatomy and Anthropology, The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel
| | - Israel Hershkovitz
- Department of Anatomy and Anthropology, The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel.
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103
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Spinal hemangiomas: results of surgical management for local recurrence and mortality in a multicenter study. Spine (Phila Pa 1976) 2015; 40:656-64. [PMID: 26030216 DOI: 10.1097/brs.0000000000000840] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter, ambispective observational study. OBJECTIVE To quantify local recurrence and mortality rates after surgical treatment of symptomatic spinal hemangiomas and identify prognostic variables for local disease control. SUMMARY OF BACKGROUND DATA Spinal hemangiomas are the most common primary tumors of the spine and are generally benign and usually asymptomatic. Because of the rarity of symptomatic spinal hemangiomas, optimal surgical treatment remains unclear. METHODS AOSpine Knowledge Forum Tumor Investigators created a multicenter database of primary spinal tumors including demographics, presentation, diagnosis, treatment, survival, and recurrence data. Tumors were classified according to Enneking and Weinstein-Boriani-Biagini. Descriptive statistics were summarized and time to mortality and recurrence was determined. RESULTS Between 1996 and 2012, 68 patients (mean age = 51 yr, SD = 16) underwent surgical treatment of a spinal hemangioma. Epidural disease was present in 55% of patients (n = 33). Pain and neurological compromise were presenting symptoms in 82% (n = 54) and 37% (n = 24) of patients, respectively. Preoperative embolization was performed in 35% of patients (n = 23), 10% (n = 7) had adjuvant radiotherapy, and 81% (n = 55) underwent posterior-alone surgery. The local recurrence rate was 3% (n = 2). Mortality secondary to spinal hemangioma was not observed (mean follow-up = 3.9 yr, SD = 3.8). CONCLUSION This is the largest multicenter surgical cohort of spinal hemangiomas. Symptomatic spinal hemangiomas are a benign tumor despite frequently presenting with epidural disease and neurological compromise. Thus, formal en bloc resection is not required, and excellent rates of local control and long-term survival can result from aggressive intralesional resection during index surgery. LEVEL OF EVIDENCE 3.
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104
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Total en bloc spondylectomy for locally aggressive vertebral hemangioma causing neurological deficits. Case Rep Orthop 2015; 2015:724364. [PMID: 25918662 PMCID: PMC4397049 DOI: 10.1155/2015/724364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 03/22/2015] [Indexed: 12/24/2022] Open
Abstract
Vertebral hemangiomas are common; however, aggressive vertebral hemangiomas with extraosseous extensions causing neurological deficits are rare. The treatment for this subtype of hemangioma remains controversial, since there are few reports on long-term clinical outcomes or tumor recurrence rates. We describe a case of aggressive vertebral hemangioma treated by total en bloc spondylectomy, with a literature review focusing on long-term recurrence. A 52-year-old male with a two-month history of numbness in the bilateral lower extremities was referred to our hospital. Imaging studies showed a tumor originating in the T9 vertebra and extending to the T8 and T10 vertebrae, with extraosseous extension causing spinal-cord compression. Ten months after onset, the patient presented with progressive paraparesis and hypalgesia. Total en bloc spondylectomy was performed, and pathology was consistent with cavernous hemangioma. Motor and sensory deficits improved significantly, and no signs of recurrence are seen at 2.5 years after operation. A review of literature revealed a recurrence rate of 12.7% (10/79 cases). The available evidence indicates satisfactory long-term outcomes for total tumor resection without adjuvant radiotherapy.
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105
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Tarantino R, Donnarumma P, Nigro L, Delfini R. Surgery in extensive vertebral hemangioma: case report, literature review and a new algorithm proposal. Neurosurg Rev 2015; 38:585-92; discussion 592. [PMID: 25720346 DOI: 10.1007/s10143-015-0616-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/26/2014] [Accepted: 11/16/2014] [Indexed: 11/24/2022]
Abstract
Hemangiomas are benign dysplasias or vascular tumors consisting of vascular spaces lined with endothelium. Nowadays, radiotherapy for vertebral hemangiomas (VHs) is widely accepted as primary treatment for painful lesions. Nevertheless, the role of surgery is still unclear. The purpose of this study is to propose a novel algorithm of treatment about VHs. This is a case report of an extensive VH and a review of the literature. A case of vertebral fracture during radiotherapy at a total dose of 30 Gy given in 10 fractions (treatment time 2 weeks) using a linear accelerator at 15 MV high-energy photons for extensive VH is reported. Using PubMed database, a review of the literature is done. The authors have no study funding sources. The authors have no conflicting financial interests. In the literature, good results in terms of pain and neurological deficits are reported. No cases of vertebral fractures are described. However, there is no consensus regarding the treatment for VHs. Radiotherapy is widely utilized in VHs determining pain. Surgery for VHs determining neurological deficit is also widely accepted. Perhaps, regarding the width of the lesion, no indications are given. We consider it important to make an evaluation before initiating the treatment for the risk of pathologic vertebral fracture, since in radiotherapy, there is no convention regarding structural changes determined in VHs. We propose a new algorithm of treatment. We recommend radiotherapy only for small lesions in which vertebral stability is not concerned. Kyphoplasty can be proposed for asymptomatic patients in which VHs are small and in patients affected by VHs determining pain without spinal canal invasion in which the VH is small. In patients affected by pain without spinal canal invasion but in which the VH is wide or presented with spinal canal invasion and in patients affected by neurological deficits, we propose surgery.
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Affiliation(s)
- Roberto Tarantino
- Department of Neurology and Psychiatry, Division of Neurosurgery, University of Rome "Sapienza", Viale del Policlinico 155, 00161, Rome, Italy
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Superior Mesenteric Artery Syndrome due to a Vertebral Hemangioma and Postpartum Osteoporosis following Treatment. Case Rep Orthop 2015; 2015:930534. [PMID: 25685576 PMCID: PMC4313671 DOI: 10.1155/2015/930534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/01/2014] [Accepted: 12/22/2014] [Indexed: 11/17/2022] Open
Abstract
In pregnancy, advanced vertebral hemangiomas may be seen, and these require treatment. The case reported here is of a 35-year-old female in the 32nd week of pregnancy who was admitted to the orthopaedics clinic with a history of backache and difficulty walking. A burst fracture of L1 associated with a vertebral hemangioma was identified with an L3 compression fracture secondary to osteoporosis. The local kyphosis angle between T12 and L2 was 27°. Kyphotic deformity was corrected and postoperatively, the measured T12–L2 local kyphotic angle was 9°. Twelve hours postoperatively, oral nutrition was allowed, but she developed nausea and vomiting and twenty-four hours postoperatively, an electrolyte imbalance developed. Postoperatively, the patient was diagnosed with superior mesenteric artery syndrome. To the best of our knowledge, this is the first reported case of superior mesenteric artery syndrome, which occurred following the correction of a kyphotic deformity that had developed secondary to an advanced hemangioma in pregnancy.
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107
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Two-stage surgical management of multilevel symptomatic thoracic haemangioma using ethanol and iliac crest bone graft. Asian Spine J 2014; 8:502-5. [PMID: 25187869 PMCID: PMC4149995 DOI: 10.4184/asj.2014.8.4.502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 10/15/2013] [Accepted: 11/13/2013] [Indexed: 11/11/2022] Open
Abstract
This article presents a 56-year-old obese female who presented with back pain and progressive weakness in her lower limbs for three months. She was bed-ridden for one week before reporting to our hospital. Plain radiographs showed vertical striations in multiple vertebrae classical of haemangioma. Magnetic resonance imaging (MRI) spine revealed multiple thoracic and lumbar vertebral haemangiomas. Extra osseous extension of haemangioma at T12 was causing spinal cord compression. Two-stage surgery was performed with absolute alcohol (ethanol) injection followed by pedicle screw fixation and decompression with tricortical iliac crest bone graft into the vertebral body. Postoperatively rapid neurological improvement was seen. After three weeks, she could walk independently. One year later, computed tomography showed complete incorporation of bone graft and maintained vertebral body height. MRI showed complete resolution of the cord edema at T12. These findings indicated diminished vascularity of the tumor.
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108
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Cherian J, Sayama CM, Adesina AM, Lam SK, Luerssen TG, Jea A. Multilevel thoracic hemangioma with spinal cord compression in a pediatric patient: case report and review of the literature. Childs Nerv Syst 2014; 30:1571-6. [PMID: 24864021 DOI: 10.1007/s00381-014-2441-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 05/12/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Vertebral hemangiomas are common benign vascular tumors of the spine. It is very rare for these lesions to symptomatically compress neural elements. If spinal cord compression does occur, it usually involves only a single level. Multilevel vertebral hemangiomas causing symptomatic spinal cord compression have never been reported in the pediatric population to the best of our knowledge. METHODS We report the case of a 15-year-old boy presenting with progressive paraparesis due to thoracic spinal cord compression from a multilevel thoracic hemangioma (T5-T10) with epidural extension. RESULTS Because of his progressive neurological deficit, he was initially treated with urgent multilevel decompressive laminectomies from T4 to T11. This was to be followed by radiotherapy for residual tumor, but the patient was unfortunately lost to follow-up. He re-presented 3 years later with recurrent paraparesis and progressive disease. This was treated with urgent radiotherapy with good response. As of 6 months follow-up, he has made an excellent neurological recovery. CONCLUSIONS In this report, we present the first case of a child with multilevel vertebral hemangiomas causing symptomatic spinal cord compression and review the literature to detail the pathophysiology, management, and treatment of other cases of spinal cord compression by vertebral hemangiomas.
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Affiliation(s)
- Jacob Cherian
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, 6621 Fannin Street, CCC 1230.01, 12th Floor, Houston, TX, 77030, USA
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109
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Magnetic resonance spectroscopy (MRS) of vertebral column - an additional tool for evaluation of aggressiveness of vertebral haemangioma like lesion. Radiol Oncol 2014; 48:137-41. [PMID: 24991203 PMCID: PMC4078032 DOI: 10.2478/raon-2013-0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 12/16/2012] [Indexed: 11/27/2022] Open
Abstract
Background Most vertebral haemangioma are asymptomatic and discovered incidentally. Sometimes the symptomatic lesions present with radiological signs of aggressiveness and their appearance resemble other aggressive lesions (e.g. solitary plasmacytoma). Case report. We present a patient with large symptomatic aggressive haemangioma like lesion in 12th thoracic vertebra in which a magnetic resonance spectroscopy (MRS) was used to analyse fat content within the lesion. The lesion in affected vertebrae showed low fat content with 33% of fat fraction (%FF). The fat content in non-affected (1st lumbar) vertebra was as expected for patient’s age (68%). Based on MRS data, the lesion was characterized as an aggressive haemangioma. The diagnosis was confirmed with biopsy, performed during the treatment – percutaneous vertebroplasty. Conclusions The presented case shows that MRS can be used as an additional tool for evaluation of aggressiveness of vertebral haemangioma like lesions.
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110
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Abstract
Different radiological methods play an important role in the work-up of patients complaining of spine pain. Depending on the symptoms and the suspected underlying etiology different methods are selected. In the following presentation we briefly present the different radiological and magnetic resonance tomography methods that are at hand, give some guidance in which method to use, and present the typical imaging findings in some of the most common conditions that presents with spine pain.
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111
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Jiang L, Liu XG, Yuan HS, Yang SM, Li J, Wei F, Liu C, Dang L, Liu ZJ. Diagnosis and treatment of vertebral hemangiomas with neurologic deficit: a report of 29 cases and literature review. Spine J 2014; 14:944-54. [PMID: 24119881 DOI: 10.1016/j.spinee.2013.07.450] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 06/25/2013] [Accepted: 07/14/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Vertebral hemangiomas (VHs) are called benign tumors but are actually just vascular malformations. The diagnosis and treatment for aggressive VHs is still controversial, due to their rarity. PURPOSE To evaluate the safety and efficiency of the present diagnostic methods and treatment choices. STUDY DESIGN A retrospective study of aggressive VHs with neurologic deficit. PATIENTS SAMPLE A total of 29 consecutive aggressive VH cases were diagnosed and treated in our department since 2001. OUTCOME MEASURES We routinely took anteroposterior and lateral spinal roentgenograms, computed tomography, and magnetic resonance images. METHODS Trocar biopsy is indicated in suspected malignant cases. Radiotherapy was usually our first choice if the neurologic deficit was mild or developed slowly. Surgery was indicated if the neurologic deficit was severe or developed quickly or if the radiotherapy was not effective. RESULTS This series included 12 males and 17 females, and the mean age at diagnosis was 44.0 years (range, 21-72 years). Ten patients had radiculopathy, 1 had cauda equina syndrome, and 18 cases had myelopathy. Twenty-one cases had lesions in the thoracic spine, 5 in the lumbar, and 3 in the cervical region. Eleven cases had untypical image findings, including five cases with pathologic vertebral fracture. The neurologic compression came from only epidural soft tumor mass in 18 cases, whereas it came from both bony compression and soft lesion in the other 11 cases. Ten cases had radiotherapy alone, but two failed and had surgery later. Twenty-one cases had surgery. In the 12 cases having surgical decompression without vertebroplasty, the average estimated blood loss was 1900 mL, and it was 1093 mL for the eight cases having decompression with vertebroplasty. The average follow-up was 51.1 months (range, 24-133 months). There was no recurrence in those cases with radiotherapy, whereas three had local recurrence in those six cases treated by surgical decompression alone without radiotherapy. CONCLUSIONS In aggressive VHs, epidural soft-tissue compression was usually the main reason for neurologic deficit. In cases with rapid progressive and/or severe myelopathy, posterior decompression and stabilization could be combined with intraoperative vertebroplasty to reduce blood loss.
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Affiliation(s)
- Liang Jiang
- Orthopaedic Department, Peking University Third Hospital, No 49. North Garden Rd, HaiDian District, Beijing 100191, China
| | - Xiao Guang Liu
- Orthopaedic Department, Peking University Third Hospital, No 49. North Garden Rd, HaiDian District, Beijing 100191, China
| | - Hui Shu Yuan
- Radiological Department, Peking University Third Hospital, No 49, North Garden Rd, HaiDian District, Beijing 100191, China
| | - Shao Min Yang
- Pathological Department of Peking University Health Science Center, No 38 XueYuan Rd, HaiDian District, Beijing 100191, China
| | - Jie Li
- Orthopaedic Department, Peking University Third Hospital, No 49. North Garden Rd, HaiDian District, Beijing 100191, China
| | - Feng Wei
- Orthopaedic Department, Peking University Third Hospital, No 49. North Garden Rd, HaiDian District, Beijing 100191, China
| | - Chen Liu
- Radiological Department, Peking University Third Hospital, No 49, North Garden Rd, HaiDian District, Beijing 100191, China
| | - Lei Dang
- Orthopaedic Department, Peking University Third Hospital, No 49. North Garden Rd, HaiDian District, Beijing 100191, China
| | - Zhong Jun Liu
- Orthopaedic Department, Peking University Third Hospital, No 49. North Garden Rd, HaiDian District, Beijing 100191, China.
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112
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Macki M, Bydon M, Kaloostian P, Bydon A. Acute compressive myelopathy due to vertebral haemangioma. BMJ Case Rep 2014; 2014:bcr-2013-200408. [PMID: 24777075 DOI: 10.1136/bcr-2013-200408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 47-year-old woman with a history of anaemia presented to the emergency room with an acute onset of leg weakness. Physical examination of the bilateral lower extremities was significant for 0/5 muscle strength in all muscle groups with decreased pinprick and temperature sensation. A sensory level at the umbilicus was appreciated. Fine touch and proprioception were preserved. Bowel and bladder function were intact. CT revealed several thoracic, vertebral haemangiomatas. An MRI was suggestive of an epidural clot at the T8-T10-weighted posterior epidural space. At the level of the lesion, the cerebrospinal fluid space was completely effaced, and the flattened spinal cord exhibited signs of oedema and compressive myelopathy. The patient immediately underwent surgical decompression of the spinal cord. An epidural clot and vessel conglomeration were identified. A postoperative spinal angiogram confirmed the diagnosis of vertebral haemangioma. At 1-month follow-up, the patient regained strength and sensation.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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113
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Gupta M, Nayak R, Singh H, Khwaja G, Chowdhury D. Pregnancy related symptomatic vertebral hemangioma. Ann Indian Acad Neurol 2014; 17:120-2. [PMID: 24753678 PMCID: PMC3992751 DOI: 10.4103/0972-2327.128577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/05/2013] [Accepted: 06/06/2013] [Indexed: 11/15/2022] Open
Abstract
Vertebral hemangiomas are benign vascular tumors of the spine that remain asymptomatic in most cases and incidentally encountered on imaging. Rarely, altered hemodynamic and hormonal changes during pregnancy may expand these benign lesions resulting in severe cord compression. The management of symptomatic vertebral hemangioma during pregnancy is controversial as modalities like radiotherapy and embolization are not suitable and surgery during pregnancy has a risk of preterm labor. Few cases of pregnancy related symptomatic vertebral hemangioma with marked epidural component have been reported in the literature. We report a case of 23-year-old primigravida who developed rapidly progressive paraparesis at 28 weeks of gestation and spine magnetic resonance imaging (MRI) revealed upper thoracic vertebral hemangioma with extensive extra-osseous extension and spinal cord compression. Laminectomy and surgical decompression of the cord was performed at 32 weeks of the pregnancy. There was significant improvement in muscle power after a week of surgery. Six weeks postoperatively she delivered a full term normal baby with subsequent improvement of neurologic deficit. Repeat MRI of dorsal spine performed at 3 months postoperatively showed reduced posterior and anterior epidural components of vertebral hemangioma.
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Affiliation(s)
- Meena Gupta
- Department of Neurology, GB Pant Hospital, New Delhi, India
| | - Rajeev Nayak
- Department of Neurology, GB Pant Hospital, New Delhi, India
| | - Hukum Singh
- Department of Neurosurgery, GB Pant Hospital, New Delhi, India
| | - Geeta Khwaja
- Department of Neurology, GB Pant Hospital, New Delhi, India
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114
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Moles A, Hamel O, Perret C, Bord E, Robert R, Buffenoir K. Symptomatic vertebral hemangiomas during pregnancy. J Neurosurg Spine 2014; 20:585-91. [PMID: 24605997 DOI: 10.3171/2014.2.spine13593] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Symptomatic vertebral hemangiomas during pregnancy are rare, as only 27 cases have been reported in the literature since 1948. However, symptomatic vertebral hemangiomas can be responsible for spinal cord compression, in which case they constitute a medical emergency, which raises management difficulties in the context of pregnancy. Pregnancy is a known factor responsible for deterioration of these vascular tumors. In this paper, the authors report 2 clinical cases of symptomatic vertebral hemangiomas during pregnancy, including 1 case of spontaneous fracture that has never been previously reported in the literature. The authors then present a brief review of the literature to discuss emergency management of this condition. The first case was a 28-year-old woman at 35 weeks of gestation, who presented with paraparesis. Spinal cord MRI demonstrated a vertebral hemangioma invading the body and posterior arch of T-3 with posterior epidural extension. Laminectomy and vertebroplasty were performed after cesarean section, allowing neurological recovery. The second case involved a 35-year-old woman who presented with spontaneous fracture of T-7 at 36 weeks of gestation, revealing a vertebral hemangioma with no neurological deficit, but it was responsible for pain and local instability. Treatment consisted of postpartum posterior interbody fusion. With a clinical and radiological follow-up of 2 years, no complications and no modification of the hemangiomas were observed. A review of the literature reveals discordant management of these rare cases, which is why the treatment course must be decided by a multidisciplinary team as a function of fetal gestational age and maternal neurological features.
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Affiliation(s)
- Alexis Moles
- Department of Neurosurgery and Neurotraumatology
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115
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Sedora-Roman NI, Gross BA, Reddy AS, Ogilvy CS, Thomas AJ. Intra-arterial Onyx Embolization of Vertebral Body Lesions. J Cerebrovasc Endovasc Neurosurg 2013; 15:320-5. [PMID: 24729960 PMCID: PMC3983534 DOI: 10.7461/jcen.2013.15.4.320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 12/09/2013] [Accepted: 12/14/2013] [Indexed: 11/23/2022] Open
Abstract
While Onyx embolization of cerebrospinal arteriovenous shunts is well-established, clinical researchers continue to broaden applications to other vascular lesions of the neuraxis. This report illustrates the application of Onyx (eV3, Plymouth, MN) embolization to vertebral body lesions, specifically, a vertebral hemangioma and renal cell carcinoma vertebral body metastatic lesion.
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Affiliation(s)
- Neda I. Sedora-Roman
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Bradley A. Gross
- Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Arra Suresh Reddy
- Division of Neurological Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Christopher S. Ogilvy
- Division of Neurological Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Ajith J. Thomas
- Division of Neurological Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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116
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Hao YJ, Yu L, Zhang Y, Wang LM, Li JZ. Surgical treatment of cervical vertebral hemangioma associated with adjacent cervical spondylotic myelopathy. Spine J 2013; 13:1774-9. [PMID: 23932778 DOI: 10.1016/j.spinee.2013.05.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 05/04/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Symptoms may vary from simple vertebral pain to progressive neurologic deficit because of cervical vertebral hemangioma associated with adjacent cervical spondylotic myelopathy (CVHAWACSM). Often resistant to conservative medical treatment, surgery has been the treatment of choice for these patients, but the optimal surgical strategy for CVHAWACSM has not been defined. PURPOSE This study aimed to investigate the methods and efficacy in the treatment of CVHAWACSM. STUDY DESIGN Retrospective review of patients enrolled in prospective randomized trial. PATIENT SAMPLE Procedure was performed in 18 patients (11 men and 7 women) with CVHAWACSM, who were enrolled between January 2006 and September 2011. OUTCOME MEASURES Radiographic examinations were carried out to assess total filling of polymethylmethacrylate in the vertebral body, fusion rates, implant failure, and general complications. The recovery of neurologic function and neck and shoulder pain relief were measured based on the Japanese Orthopedic Association (JOA) and the visual analog scale (VAS) scores. METHODS Eighteen patients had single vertebral hemangioma, including one case at C₃, three at C₄, six at C₅, five at C₆, and three at C₇. The X-ray films showed a typical "palisade" change. According to the clinical and imaging features, there were 12 cases of Type II and 6 of Type IV cervical hemangioma. Standard anterior cervical decompression and fusion with a stand-alone polyetheretherketone cage (filled with autologous cancellous iliac bone) was performed, followed by vertebroplasty. Clinical and radiologic follow-ups were performed. RESULTS The mean follow-up was 24.1 months, with a range of 18 to 36 months. The symptoms of all 18 patients were improved, by varying degrees, and the lesion vertebra did not show anterior bone cement leakage or injuries in the spinal cord and nerves. The forming vertebra did not show fracture or collapse, and there was no recurrence of the hemangioma. During the follow-up, there was no implant loosening, displacement, or breakage. The JOA and the VAS scores were significantly recovered at 3 months after the operation and in the last follow-up, compared with the preoperative level (p<.05). The JOA scores in the last follow-up showed 13 excellent, 4 good, 1 fair, and 0 poor cases. CONCLUSIONS This procedure seems to be a safe efficient method to treat symptomatic CVHAWACSM. It seems to serve the purpose of providing vertebral augmentation, cord decompression, and rigid fusion at the same sitting. Although the present outcomes are promising, long-term follow-up studies with larger patient numbers are required to confirm this effect.
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Affiliation(s)
- Ying-jie Hao
- Department of Orthopaedics, The First Affiliated Hospital, Zhengzhou University, No.1, Eastern Jianshe Road, Zhengzhou 450052, China.
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Yu B, Wu D, Shen B, Zhao W, Huang Y, Zhu J, Qi D. Noncontiguous lumbar vertebral hemangiomas treated by posterior decompression, intraoperative kyphoplasty, and segmental fixation. J Neurosurg Spine 2013; 20:60-6. [PMID: 24236666 DOI: 10.3171/2013.10.spine13499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Vertebral hemangiomas are benign lesions and are often asymptomatic. Most vertebral hemangiomas that cause cord compression and neurological symptoms are located in the thoracic spine and involve a single vertebra. The authors report the rare case of lumbar hemangiomas in a 60-year-old woman presenting with severe back pain and rapidly progressive neurological signs attributable to 2 noncontiguous lesions. After embolization of the feeding arteries, no improvement was noted. Thus, the authors performed open surgery using a combination of posterior decompression, intraoperative kyphoplasty, and segmental fixation. The patient experienced relief from back and leg pain immediately after surgery. At 3 months postoperatively, her symptoms and neurological deficits had improved completely. To the authors' knowledge, this is the first description of 2 noncontiguous extensive lumbar hemangiomas presenting with neurological symptoms managed by such combined treatment. The combined management seems to be an effective method for treating symptomatic vertebral hemangiomas.
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Affiliation(s)
- Bin Yu
- Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Clinical and radiological presentation of spinal epidural haemangiomas: clinical series in a tertiary care centre during a 10-year period. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23:404-10. [PMID: 24097259 DOI: 10.1007/s00586-013-3045-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 09/24/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Haemangiomas are very frequent benign spinal tumours. However, pure epidural location is extremely rare. At present, only 52 cases have been reported in the literature during the last 10 years. We proposed to analyse clinical and radiological features of this rare entity treated in a tertiary care centre over the last 10 years. METHODS A study of a retrospective surgical series (2002-2012) was conducted. The clinic's electronic database was searched for "spinal" and/or "vertebral haemangiomas", which were treated by surgery and/or vertebroplasty. Clinical, radiological and histopathological data were analysed. RESULTS In total, the series comprised 30 spinal haemangiomas. There were 6 epidural (20 %), 17 vertebral (57 %) and 7 intradural lesions (23 %). There were four men and two women, mean age 28.3 years, with epidural lesions. One patient presented with localised back pain only, two with radiculopathy and focal neurological deficit, two with radiculopathy only and one with isolated focal neurological deficit, respectively. The onset of symptoms was progressive in four cases over weeks to months and sudden in two cases. Preoperative MRI imaging revealed features of meningioma, neurinoma or metastasis. CONCLUSION Epidural haemangiomas are extremely rare spinal lesions. They may mimic more common spinal tumours clinically and radiologically. The usual treatment is gross total resection confirming the diagnosis histologically.
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Melcher C, Wegener B, Niederhagen M, Jansson V, Birkenmaier C. An intramedullary capillary hemangioma of the spine with an underlying plasmocytoma. Spine J 2013; 13:e1-4. [PMID: 23498927 DOI: 10.1016/j.spinee.2013.01.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 09/17/2012] [Accepted: 01/25/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In contrast to vertebral hemangiomas, which are very common within the general population, only 3% to 5% of patients with plasma cell dyscrasia show a single osteolytic bone lesion due to plasma cell infiltration without the evidence of generalized myeloma. The vast majority of these hemangiomas are completely asymptomatic and only discovered incidentally. In rare occasions, representing only 1% to 2% of the known lesions, a locally aggressive subtype can cause problems analogous to the ones triggered by a plasmocytoma, ranging from back pain to vertebral compression fractures to neurologic deficit, resulting from nerve root or spinal cord compression. Both entities are extensively discussed in the literature, but finding both lesions in one is rare if not described for the first time. PURPOSE To advise colleagues that the differential diagnosis between benign and malignant vertebral tumors can be harder than expected and has to be definitely made to avoid severe consequences for the patient. PATIENT SAMPLE A 46-year-old healthy man presented to the emergency department with an acute onset of thoracic back pain after a trivial incident. Although his medical history included no known diseases and no history of back pain, plain X-rays raised the clear suspicion of a fracture of T6 that was verified in computed tomography scans. OUTCOME MEASURES Visual analog scale; neurologic status; tumor recurrence. METHODS The case of the patient was evaluated retrospectively according to standard procedures, clinical outcome, and in review of the literature. RESULTS Because there is still controversy about the best treatment (local radiation vs. operation vs. combination) of a solitary skeletal plasmocytoma, no gold standard has been established until now. Especially if a patient needs an emergency operation before all test results are obtained, each surgeon has to decide individually. CONCLUSIONS Capillary hemangiomas can hide underlying plasmocytomas, which might demand totally different treatment strategies. Although our patient did not match the common criteria for a solitary plasmocytoma, one has to discuss whether a stand-alone decompression and biopsy would have been the emergency treatment of choice. Such a strategy would have reduced the risk of tumor spreading and would have made radiotherapy easier, whereas on the other hand requiring a secondary stabilization procedure later on.
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Affiliation(s)
- Carolin Melcher
- Department of Orthopaedic Surgery, University Hospital Munich, Ludwig-Maximilians University, Campus Grosshadern, Marchioninistr.15, 81377 Munich, Germany.
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Uzunaslan D, Saygin C, Gungor S, Hasiloglu Z, Ozdemir N, Celkan T. Novel use of propranolol for management of pain in children with vertebral hemangioma: report of two cases. Childs Nerv Syst 2013; 29:855-60. [PMID: 23306960 DOI: 10.1007/s00381-012-2012-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 12/19/2012] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Vertebral hemangioma (VH) is an exceedingly rare neoplasm in pediatric population with less than 10 cases reported in the literature. It is usually asymptomatic in adults and diagnosed incidentally at radiographic investigations of other medical conditions. In this report, we describe two children who presented to our institution with severe back pain and were diagnosed with VH. CASE REPORTS Case 1 was an 8-year-old male with a pain score of 10 out of 10 at presentation. Clinical investigations eliminated the possibility of a neoplasm or infectious process and MRI findings were highly suggestive of an aggressive vertebral hemangioma. Case 2 was a 17-year-old female who presented with back pain radiating to shoulders. Her pain score was 4 out of 10 and she was diagnosed with vertebral hemangioma due to the specific findings on MRI studies. DISCUSSION Both patients received propranolol with a dose of 20 and 40 mg per day, respectively. They were free of pain at 2 months follow-up. There are different invasive treatment modalities for the management of VH, including vertebroplasty, kyphoplasty, radiotherapy, alcohol injection, embolization, and surgery. These methods have been used in adult patients for several years, but each of them has potential risks which make these options unsuitable for children. CONCLUSION Propranolol is a beta blocker which is safely used in the management of infantile hemangiomas. This is the first report demonstrating its efficacy in symptomatic treatment of childhood VH. The lesions did not show any regression, but the pain relief obtained was very significant under propranolol therapy.
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Affiliation(s)
- Didem Uzunaslan
- Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
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Liu XW, Jin P, Wang LJ, Li M, Sun G. Vertebroplasty in the treatment of symptomatic vertebral haemangiomas without neurological deficit. Eur Radiol 2013; 23:2575-81. [PMID: 23620368 DOI: 10.1007/s00330-013-2843-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 02/19/2013] [Accepted: 02/24/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of vertebroplasty in symptomatic vertebral haemangiomas (VHs) with no neurological deficit, with or without features of aggressiveness in imaging studies. METHODS A retrospective study was conducted to review 31 consecutive patients with symptomatic VHs that underwent vertebroplasty procedures (13 males, 18 females; mean age, 57.5 years), for a total of 33 affected vertebral levels (range, T4-L5 levels). Pre procedure radiological examinations were reviewed. The presence of predominant soft tissue stroma on CT, low signals on T1W of MRI, epidural tissue, and cortical erosion are considered features of aggressiveness. The clinical effects were evaluated using the visual analogue scale (VAS) and modified Roland-Morris Disability Questionnaire (RDQ) at the pre and each postoperative follow-up time point (mean follow-up of 15.8 months). RESULTS Symptomatic VHs with no signs of aggressiveness were observed in 26 lesions and those with signs of aggressiveness in 7 lesions. Vertebroplasty was successfully performed under fluoroscopic guidance with a unipedicular approach in 16 levels, a bipedicular approach in 17 levels. VAS scores and RDQ scores were significantly improved after vertebroplasty (P < 0.001). Extraosseous cement leakage was observed in 4 patients without clinical complications. CONCLUSIONS Vertebroplasty is an optional treatment for symptomatic VHs with no neurological deficit. KEY POINTS • Vertebral haemangiomas with or without aggressive signs may cause pain. • Radiological signs of aggressiveness include evidence of lesions that contain less fat predominance, evidence of epidural soft tissue and evidence of cortical erosion. • Vertebroplasty provides effective treatment for symptomatic vertebral haemangiomas causing no neurological deficit.
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Affiliation(s)
- Xun-Wei Liu
- Department of Medical Imaging, Jinan Military General Hospital, No,25, Shifan Road, Jinan, Shandong, China, 250031.
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Abstract
An F-FDG-PET with CT scan was performed to stage a tongue cancer, revealing the hypermetabolic region in the thoracic vertebra. This corresponded to a benign lesion seen on MRIs and CT.Although these findings suggested a vertebral hemangioma, "hot" vertebra in FDG-PET was atypical. The final diagnosis was confirmed capillary hemangioma by the scopic biopsy and this lesion was no change at 1 year later.Careful interpretation of metabolic (FDG-PET) and anatomic (CT and MRI) images should be performed to accurately characterize the foci of increased FDG uptake.
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Armaganian G, Adetchessi T, Pech-Gourg G, Blondel B, Dufour H, Fuentes S. L1 burst fracture with associated vertebral angioma. Orthop Traumatol Surg Res 2013; 99:241-6. [PMID: 23453277 DOI: 10.1016/j.otsr.2012.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 12/07/2012] [Accepted: 12/30/2012] [Indexed: 02/02/2023]
Abstract
Vertebral angioma is a common bone tumor. We report a case of L1 vertebral angioma revealed by type A3.2 traumatic pathological fracture of the same vertebra. Management comprised emergency percutaneous osteosynthesis and, after stabilization of the multiple trauma, arterial embolization and percutaneous kyphoplasty.
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Affiliation(s)
- G Armaganian
- Neurosurgery Deptartment, Timone Hospital, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
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Abstract
STUDY DESIGN Retrospective cohort analysis. OBJECTIVE To evaluate the neurological outcomes after resection of intramedullary, intradural extramedullary, and extradural hemangiomas. SUMMARY OF BACKGROUND DATA Spinal hemangiomas most commonly arise in the vertebral bodies and are typically asymptomatic. Uncommonly, hemangiomas may cause significant neurological deficits via extraosseous extension. Intramedullary hemangiomas may also occur and account for approximately 5% of all spinal cord lesions, with those located intradural extramedullary occurring rarely. Although retrospective studies have primarily examined the neurological outcome of intramedullary and vertebral hemangiomas, there is little literature comparing outcomes after surgical treatment of hemangiomas of varying location. METHODS We performed a retrospective review of all patients treated for hemangiomas affecting the spinal cord at our institution between 1999 and 2012. Various patient, clinical, and tumor data were collected including patient demographics, neurological examinations, and procedure, clinic, and pathology notes. Imaging studies were evaluated to determine the extent of resection, presence of recurrence, and lesion volume. Functional status was defined using the Modified McCormick Scale (MMS). RESULTS A total of 19 patients were evaluated, with our cohort consisting of 8 intramedullary, 5 intradural extramedullary, and 6 vertebral hemangiomas with extraosseous extension. Cavernous hemangiomas were most common (47.4%), followed by those of the capillary type. At long-term follow-up, 73.7% of patients had improved neurological outcome and 15.8% had worsened. However, only 50% of patients with intramedullary hemangiomas improved, compared with 80% and 100% for intradural extramedullary and vertebral hemangiomas, respectively. Also, those with intramedullary lesions more frequently had worse outcomes after surgery (25%) than those with intradural extramedullary (20%) and vertebral hemangiomas (0%). CONCLUSION Although all patients typically present with a similar functional status, patients with intramedullary lesions are more unlikely to improve after surgical resection and derive less of a benefit compared with those with intradural extramedullary and vertebral hemangiomas.
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Mavrogenis AF, Rossi G, Calabrò T, Altimari G, Rimondi E, Ruggieri P. The role of embolization for hemangiomas. Musculoskelet Surg 2012; 96:125-135. [PMID: 22684541 DOI: 10.1007/s12306-012-0207-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 05/24/2012] [Indexed: 06/01/2023]
Abstract
We retrospectively studied 31 patients with painful bone (15 patients) and soft-tissue (16 patients) hemangiomas treated with 39 embolizations using N-2-butyl cyanoacrylate from 2003 to 2010. The mean tumor size before embolization was 6 cm for bone and 7 cm for soft-tissue hemangiomas. The technique of embolization was the same for bone and soft-tissue lesions. Preoperative embolization was done in six patients, while the remaining patients had embolization as only treatment. The mean follow-up was 47 months (11-89 months). The clinical and imaging effect of treatment was evaluated at follow-up with a pain score scale, tumor size, and ossification. In four patients, embolization was not feasible because of the inability to catheterize and low blood flow of the feeding vessels. Nine patients with bone and 10 with soft-tissue hemangiomas experienced complete pain relief. Four patients with bone and four with soft-tissue hemangiomas experienced recurrence of pain and were treated with repeat embolization. Re-recurrences were not observed in any of the patients with soft-tissue hemangiomas until the period of this study. Ossification and tumor size reduction were higher for bone hemangiomas. Embolization-related complications were more common for soft-tissue hemangiomas.
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Affiliation(s)
- Andreas F Mavrogenis
- Department of Orthopaedics, Orthopaedic Oncology Service, Istituto Ortopedico Rizzoli, University of Bologna, Via Di Barbiano 1/10, 40136, Bologna, Italy.
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Low back pain in a child associated with acute onset cauda equina syndrome: a rare presentation of an aggressive vertebral hemangioma: a case report. J Pediatr Orthop 2012; 32:271-6. [PMID: 22411333 DOI: 10.1097/bpo.0b013e318247195a] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Back pain prevalence in the pediatric age group is less compared with adults. There is a wide range of possible etiologies, and tumors such as primary spinal hemangiomas are uncommon. Most are incidental findings and asymptomatic; however, painful lesions can be presented in up to 0.9% to 1.2% of cases. These lesions can produce neurologic involvement either spinal cord compression or cauda equina syndrome as in our case. The aim of this study is to describe a case of low back pain in a child due to a vertebral hemangioma complicated with acute cauda equina syndrome, and performed a literature review that will help us to recognize this aggressive variance making an early treatment feasible. METHODS A 13-year-old female, follow-up in an outer health care center due to a L1 vertebral hemangioma, characterized by 3 years of low back pain without neurologic symptoms presented to our emergency department with an acute cauda equina syndrome. RESULTS An outside magnetic resonance imaging showed complete obliteration of the spinal canal at the level of the conus medullaris related to retropulsion of bone at L1. She underwent 2-stage surgical treatment: complete posterior L1 laminectomy and partial T12-L2 laminectomies, with partial L1 vertebrectomy and posterior fusion with instrumention from T11 to L3. Three weeks later, embolization before anterior fusion with inner body cage was performed. Forty months after surgery, she is doing well with no neurologic deficits. CONCLUSIONS Even though hemangiomas are not a common cause of back pain, they should be taken into account. It is important to recognize the aggressive variance so an early treatment could be performed. There is no enough clinical data to establish guidelines of management in children, therefore, the treatment should be individualized.
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Aggressive vertebral hemangioma of the thoracic spine without typical radiological appearance. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21:1994-9. [PMID: 22732826 DOI: 10.1007/s00586-012-2349-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 04/22/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE Vertebral hemangioma (VH) is virtually vascular malformation, which is usually asymptomatic. Only 3.7 % of VH may become active and symptomatic, and 1 % may invade the spinal canal and/or paravertebral space. Treatment protocols for active or aggressive VHs are still in controversy. Reported treatments include radiotherapy, vertebroplasty, direct alcohol injection, embolization, surgery and a combination of these modalities. METHODS A 41-year-old lady was presented with 18 month history of intermittent back pain. CT revealed T5 osteolytic lesion with epidural and paravertebral extension. The first CT guided biopsy yielded little information. RESULTS Histopathological diagnosis of the second biopsy was VH. Vertebroplasty, posterior decompression and fixation were performed followed by postoperative radiotherapy. Her symptoms were resolved immediately after the operation. At 12 months follow-up, no recurrence was detected by CT with contrast enhancement. CONCLUSION Surgical decompression, vertebroplasty and fixation are safe and effective for aggressive VH. More attention is needed in determining the algorithm for the diagnosis and treatment of aggressive VH.
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Ropper AE, Cahill KS, Hanna JW, McCarthy EF, Gokaslan ZL, Chi JH. Primary vertebral tumors: a review of epidemiologic, histological, and imaging findings, Part I: benign tumors. Neurosurgery 2012; 69:1171-80. [PMID: 21725252 DOI: 10.1227/neu.0b013e31822b8107] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Primary vertebral tumors, although less common than metastases to the spine, make up a heterogeneous group of neoplasms that can pose diagnostic and treatment challenges. They affect both the adult and the pediatric population and may be benign, locally aggressive, or malignant. An understanding of typical imaging findings will aid in accurate diagnosis and help neurosurgeons appreciate anatomic subtleties that may increase their effective resection. An understanding of the histological similarities and differences between these tumors is imperative for all members of the clinical team caring for these patients. In this first review of 2 parts, we discuss the epidemiological, histological, and imaging features of the most common benign primary vertebral tumors-aneurysmal bone cyst, chondroma and enchondroma, hemangioma, osteoid osteoma, and osteoblastoma-and lesions related to eosinophilic granuloma and fibrous dysplasia. In addition, we discuss the basic management paradigms for each of these diagnoses. In combination with part II of the review, which focuses on locally aggressive and malignant tumors, this article provides a comprehensive review of primary vertebral tumors.
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Affiliation(s)
- Alexander E Ropper
- Department of Neurosurgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
In accordance with extending survival periods of cancer patients, number of consecutively developing metastatic spinal tumor is also increasing. There have been improvements in the treatment results of metastatic spine tumor by virtue of the developments in diagnostic radiology, chemotherapy, adjuvant treatment, operative device and technique, discrete preoperative plan, and standardized operation. Accordingly, surgical indication has also increased. Clinically, in case of metastatic spine tumor, treatment of tumor itself should be focused on pain relief, preservation of neurologic function, prevention of pathologic fracture, prevention of pathologic fracture, and correction of spinal instability for improving quality of life, rather than for extension of survival. Additionally, etiology of spinal tumor, correct diagnosis and subsequent treatment principles should be thoroughly understood before establishing treatment plans for effective treatments.
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Boschi V, Pogorelić Z, Gulan G, Perko Z, Grandić L, Radonić V. Management of cement vertebroplasty in the treatment of vertebral hemangioma. Scand J Surg 2012; 100:120-4. [PMID: 21737389 DOI: 10.1177/145749691110000210] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The vertebral hemangiomas are benign vascular lesions occurring in spine. Although uncommon, symptomatic vertebral hemangiomas can be painful and can limit daily activities. A number of methods have been used in the treatment of symptomatic and aggressive vertebral hemangioma, but none of them is optimal. Treatment with cement vertebroplasty showed very good results. This study aims to illustrate the validity of the treatment with cement vertebroplasty in patients with painful vertebral hemangiomas. PATIENTS AND METHODS From January 2000 to January 2007, 24 patients were treated by percutaneous vertebroplasty because of hemangioma: 16 thoracic, 8 lumbar. There were 11 males and 13 females. The average age at the time of surgery was 48 years. All the patients complained of a pain syndrome resistant to continuing medication. All patients underwent X-ray examination, CT-scan and MR of the involved level preoperatively. A unipedicular approach under fluoroscopic guidance has been performed in all patients. All procedures have been carried out under the local anesthesia. The mean follow-up was 5.8 years. RESULTS In all the patients a successful outcome has been observed with a complete resolution of pain symptom. Extravertebral vascular cement leakage has been observed in 3 patients, without any clinical radicular syndrome onset due to the epidural diffusion. Clinical and radiological follow-up showed stability of the treatment and absence of pain in all patients. CONCLUSION Percutaneous treatment with vertebroplasty for symptomatic vertebral hemangiomas is a valuable, less-invasive, and a quick method that allows a complete and enduring resolution of the painful vertebral symptoms without findings of the vertebral body's fracture.
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Affiliation(s)
- V Boschi
- Department of Surgery, University Hospital Split and Split University School of Medicine, Split, Croatia
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Nair AP, Kumar R, Srivastav AK, Sahu RN, Kumar B. Outcome of dorsolumbar vertebral hemangiomas presenting with neuraxial compression. Indian J Orthop 2012; 46:536-41. [PMID: 23162146 PMCID: PMC3491787 DOI: 10.4103/0019-5413.101033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hemangiomas are benign vascular tumors associated with proliferation of blood vessels in bone or soft tissue and they are usually incidental findings in vertebrae. When symptomatic, they present with features of radiculopathy, myelopathy, or vertebral fractures. Treatment options are varied, include sole embolization, embolization combined with surgical excision, surgical excision alone, percutaneous ablation, and radiotherapy. We hereby describe a series of seven cases of symptomatic vertebral hemangiomas operated from 2006 to 2009. MATERIALS AND METHODS Their clinical and radiological profile and outcome have been described. All patients were subjected to surgical excision followed by instrumentation. Outcome was assessed at a followup of 2 years following surgery with Frankel grading system. RESULTS Seven patients (five females and two males) were included in the study. The mean age was 33.85 years with the mean duration of symptoms of 12 months. All seven cases were symptomatic vertebral hemangiomas with cord compression and underwent surgical excision. Preoperatively, patients with poor Frankel grade such as A and B improved postoperatively to C, D, or E. CONCLUSION Surgical excision of these lesions is difficult due to the tremendous amount of intraoperative bleeding. During surgery, brisk bleeding is usually encountered, but can be brought under control with adequate preoperative preparation and expertize. Preoperative embolization may help to reduce the bleeding, but at times it may be difficult to do if vertebrae are replaced by a solid hard mass. In spite of the risks associated with surgery, it still is the treatment of choice as a single intervention, especially in aggressive vertebral hemangiomas.
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Affiliation(s)
- Anup P Nair
- Department of Neurosurgery, S.G.P.G.I.M.S., Lucknow, India
| | - Raj Kumar
- Department of Neurosurgery, S.G.P.G.I.M.S., Lucknow, India,Address for correspondence: Prof. Raj Kumar, Department of Neurosurgery, Officer in Charge, Trauma Centre, S.G.P.G.I.M.S., Lucknow 14, India. E-mail:
| | | | | | - Brijesh Kumar
- Department of Neurosurgery, S.G.P.G.I.M.S., Lucknow, India
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Abstract
Vertebral hemangiomas are common lesions and usually considered benign. A rare subset of them, however, are characterized by extra-osseous extension, bone expansion, disturbance of blood flow, and occasionally compression fractures and thereby referred to as aggressive hemangiomas. We present a case of a 67-year-old woman with progressive paraplegia and an infiltrative mass of T4 vertebra causing mass effect on the spinal cord. Multiple conventional imaging modalities were utilized to suggest the diagnosis of aggressive hemangioma. Final pathologic diagnosis after decompressive surgery confirmed the diagnosis of an osseous hemangioma.
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Affiliation(s)
- Wesley B Schrock
- Department of Radiology, University of Mississippi School of Medicine, Jackson, MS 39216, USA.
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Hwang SL, Wu CH, Chen YT, Tsai TH, Chu CW, Lee KS. Monoparesis of the leg caused by thoracic vertebral hemangioma: a case report. Neurol Sci 2011; 33:709-10. [PMID: 21935683 DOI: 10.1007/s10072-011-0787-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 09/13/2011] [Indexed: 11/25/2022]
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Abstract
Bone tumors may present as incidental findings, with pain or loss of function, or as fractures. There is a broad range of indications for transarterial embolization (TAE) in primary or metastatic bone tumors: to reduce operative hemorrhagic risks, to simplify or allow more definitive surgery, or in the context of pain palliation, fever, bleeding, or hypercalcemic and other rheological factors. Embolization may also increase tumor sensitivity to chemotherapy or radiation therapy. The procedure itself is often complex with significant risk to adjacent structures and is usually part of a wider treatment strategy. There are many options of embolic agent, techniques, and end points but all aim to devascularize the tumor. Catheter angiography at the time of TAE is used to determine the correct embolic agent and technique with care taken to isolate at risk structures. Many factors determine the best choice of embolic material, probably the most important of which is operator experience. In life-threatening situations or in preoperative embolizations of metastatic tumors, many operators opt for a combination of particulate emboli and stainless steel or platinum coils. Agents discussed include polyvinyl alcohol particles, trisacryl microspheres, gelatin sponge, liquid embolic agents, and embolization coils. Tumor types treated include vascular metastatic lesions, commonly renal cell or thyroid, particularly in locations prone to fracture; giant cell tumors; aneurysmal bone cysts; vertebral hemangiomas, osteosarcomas; arteriovenous malformations; and osteoblastomas. TAE should be considered in the treatment algorithm of primary or secondary bone tumors. Specific benefit is present where there is a high risk of bleeding at surgery, where there is spinal involvement and neural encroachment, where active bleeding is present or in awkward surgical locations where prolonged surgery is anticipated.
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Affiliation(s)
- Richard J T Owen
- Assistant Professor of Radiology, University of Alberta, Edmonton, Alberta, Canada
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Vinay S, Khan SK, Braybrooke JR. Lumbar vertebral haemangioma causing pathological fracture, epidural haemorrhage, and cord compression: a case report and review of literature. J Spinal Cord Med 2011; 34:335-9. [PMID: 21756575 PMCID: PMC3127359 DOI: 10.1179/2045772311y.0000000004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT Vertebral haemangiomas are recognized to be one of the commonest benign tumours of the vertebral column, occurring mostly in the thoracic spine. The vast majority of these are asymptomatic. Infrequently, these can turn symptomatic and cause neurological deficit (cord compression) through any of four reported mechanisms: (1) epidural extension; (2) expansion of the involved vertebra(e) causing spinal canal stenosis; (3) spontaneous epidural haemorrhage; (4) pathological burst fracture. Thoracic haemangiomas have been reported to be more likely to produce cord compression than lumbar haemangiomas. FINDINGS A forty-nine year old male with acute onset spinal cord compression from a pathological fracture in a first lumbar vertebral haemangioma. An MRI delineated the haemangioma and extent of bleeding that caused the cord compression. These were confirmed during surgery and the haematoma was evacuated. The spine was instrumented from T12 to L2, and a cement vertebroplasty was performed intra-operatively. Written consent for publication was obtained from the patient. CLINICAL RELEVANCE The junctional location of the first lumbar vertebra, and the structural weakness from normal bone being replaced by the haemangioma, probably caused it to fracture under axial loading. This pathological fracture caused bleeding from the vascularized bone, resulting in cord compression.
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Affiliation(s)
| | - SK Khan
- Correspondence to: SK Khan, 103 Kildale House, Marton Road, Middlesbrough TS4 3TG, UK.
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Cheung NK, Doorenbosch X, Christie JG. Rapid onset aggressive vertebral haemangioma. Childs Nerv Syst 2011; 27:469-72. [PMID: 21246374 DOI: 10.1007/s00381-011-1391-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 01/04/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Vertebral haemangiomas are generally benign asymptomatic vascular tumours seen commonly in the adult population. Presentations in paediatric populations are extremely rare, which can result in rapid onset of neurological symptoms. We present a highly unusual case of an aggressive paediatric vertebral haemangioma causing significant cord compression. CASE REPORT A 13-year-old boy presented with only 2 weeks duration of progressive gait disturbance, truncal ataxia and loss of bladder control. Magnetic resonance imaging (MRI) of the spine revealed a large vascular epidural mass extending between T6 and T8 vertebral bodies. Associated displacement and compression of the spinal cord was present. A highly vascular bony lesion was found during surgery. Histopathology identified this tumour to be a vertebral haemangioma. DISCUSSION We present an extremely unusual acute presentation of a paediatric vertebral haemangioma. This study highlights the need for early diagnosis, MRI for investigation and urgent surgical management.
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Affiliation(s)
- Nicholas K Cheung
- Department of Neurosurgery, John Hunter Hospital, Newcastle, Australia.
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Shinozaki M, Morita A, Kamijo K, Seichi A, Saito N, Kirino T. Symptomatic T2 vertebral hemangioma in a pregnant woman treated by one stage combination surgery; posterior stabilization and anterior subtotal tumor resection. Case report. Neurol Med Chir (Tokyo) 2011; 50:674-7. [PMID: 20805653 DOI: 10.2176/nmc.50.674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 27-year-old woman presented with vertebral hemangioma manifesting as sudden onset of paraplegia, and bladder and bowel dysfunction during pregnancy. Magnetic resonance imaging revealed a mass lesion that had infiltrated into the entire T2 vertebral body and expanded to the vertebral canal. Laminectomy from T1 to T3 and biopsy of the lesion were performed. Biopsy confirmed the diagnosis of vertebral hemangioma, but laminectomy resulted in no neurological changes. The patient was transferred to our hospital, where radical treatment comprising embolization of the feeding arteries, posterior stabilization of the vertebrae, and anterior excision of the tumor was performed. Symptoms resolved gradually but steadily, and she made a full recovery by 18 months postoperatively. Radical operation might be extremely effective for extradural vertebral hemangioma, even in the delayed phase or in the presence of severe neurological deficit.
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Affiliation(s)
- Munehisa Shinozaki
- Department of Neurosurgery, Faculty of Medicine, Tokyo University, Tokyo, Japan
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Singh P, Mishra NK, Dash HH, Thyalling RK, Sharma BS, Sarkar C, Chandra PS. Treatment of Vertebral Hemangiomas With Absolute Alcohol (Ethanol) Embolization, Cord Decompression, and Single Level Instrumentation: A Pilot Study. Neurosurgery 2011; 68:78-84; discussion 84. [DOI: 10.1227/neu.0b013e3181fc60e9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Vertebral hemangiomas (VH) are the most common lesions of the vertebral column.
OBJECT:
To evaluate the role of intraoperative ethanol embolization, surgical decompression, and instrumented fusion in VH presenting with myelopathy.
METHODS:
This is was a prospective study of single-level symptomatic VH with cord compression. Exclusions were as follows: pathological fractures, deformity, or multilevel pathologies. Surgery consisted of intraoperative bilateral pedicular absolute alcohol injection and laminectomy at the level of pathology followed by a short-segment instrumented fusion using pedicle screws.
RESULTS:
Ten patients (mean, 26.8 ± 18.11; range, 10-68 years; 8 females) were treated with use of this technique. Clinical features included myelopathy with motor and sensory involvement in all (4 paraplegic), sphincter involvement (8), and severe local pain (5). The preoperative American Spinal Injury Association (ASIA) scores were A (3), B (1), and C (6). All had pan vertebral body VH with severe cord compression. The mean surgical time was 102 ± 22 minutes; average blood, 296 ± 90.82 mL. Mean amount of absolute alcohol injected was 12.6 ± 4.7 mL (1 requiring 25 mL). Immediate embolization was achieved in all patients allowing laminectomy and soft-tissue hemangioma removal. Postsurgery, all patients showed improvement (sphincters improved in 4) at a follow-up ranging 12 to 26 months (transient neurological deterioration in 1). Postsurgery ASIA scores were D (5) and E (5) at last follow-up. Two patients showed evidence of bone sclerosis on follow-up CT scans at 1.2 and 1.5 years.
CONCLUSION:
This procedure seems to be a safe, efficient method to treat VH with severe cord compression. It seems to serve the purpose of providing embolization, cord decompression, and rigid fusion at the same sitting.
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Affiliation(s)
- Pankaj. Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Nalin K. Mishra
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Hari Har. Dash
- Department of Neuroanesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajender K. Thyalling
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Bhawani S. Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Chitra. Sarkar
- Department of Neuropathology, All India Institute of Medical Sciences, New Delhi, India
| | - P Sarat. Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Jankowski R, Nowak S, Zukiel R, Szymaś J, Sokół B. Surgical treatment of symptomatic vertebral haemangiomas. Neurol Neurochir Pol 2011; 45:577-582. [DOI: 10.1016/s0028-3843(14)60125-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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141
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Vertebroplasty and Kyphoplasty. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00180-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Anselmetti GC, Bonaldi G, Carpeggiani P, Manfrè L, Masala S, Muto M. Vertebral Augmentation: 7 Years Experience. ADVANCES IN MINIMALLY INVASIVE SURGERY AND THERAPY FOR SPINE AND NERVES 2011; 108:147-61. [DOI: 10.1007/978-3-211-99370-5_23] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Urrutia J, Postigo R, Larrondo R, Martin AS. Clinical and imaging findings in patients with aggressive spinal hemangioma requiring surgical treatment. J Clin Neurosci 2010; 18:209-12. [PMID: 21177111 DOI: 10.1016/j.jocn.2010.05.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/18/2010] [Accepted: 05/22/2010] [Indexed: 11/19/2022]
Abstract
Vertebral hemangiomas (VHs) are frequently asymptomatic lesions found incidentally during investigations for other spinal problems. Symptomatic VHs are less common, and there are few reports of compressive VHs in the literature. VHs with aggressive behavior present with low signal intensity on T1-weighted and high signal intensity on T2-weighted MRI. We present a case series of four patients with compressive VH, all of whom were neurologically compromised. Each of the four patients underwent preoperative arterial embolization followed by surgical treatment of their VHs. All patients recovered normal motor function after surgery. At follow-up (average 53 months), one patient had a recurrent tumor requiring reoperation and radiotherapy. Although it is rare, aggressive VH can be a devastating condition. Total surgical resection or subtotal resection with radiotherapy may be warranted.
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Affiliation(s)
- Julio Urrutia
- Department of Orthopaedic Surgery, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Chile.
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Bellomia D, Viglianesi A, Messina M, Caltabiano G, Chiaramonte R, Pero G, Chiaramonte I. Vertebral Aggressive Hemangioma. Neuroradiol J 2010; 23:629-32. [DOI: 10.1177/197140091002300514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 05/29/2010] [Indexed: 11/15/2022] Open
Abstract
Aggressive hemangiomas are rare and can compress the spinal cord, nerve roots or both, producing myelopathy or radiculopathy. This report describes an aggressive and compressive hemangioma of the body of the Th9 vertebra in a woman with symptoms of medullary sufferance, treated with embolization of the afferent vessels of the lesion followed by radiotherapy.
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Affiliation(s)
- D. Bellomia
- Department of Radiology, University of Catania; Catania, Italy
| | - A. Viglianesi
- Department of Radiology, University of Catania; Catania, Italy
| | - M. Messina
- Department of Radiology, University of Catania; Catania, Italy
| | - G.A. Caltabiano
- Department of Radiology, University of Catania; Catania, Italy
| | - R. Chiaramonte
- Department of Otorhinolaryngology, University of Catania; Catania, Italy
| | - G. Pero
- Department of Neurosciences, University of Catania; Catania, Italy
| | - I. Chiaramonte
- Department of Neurosciences, University of Catania; Catania, Italy
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145
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Vertebral hemangioma: an important differential in the evaluation of locally aggressive spinal lesions. Spine (Phila Pa 1976) 2010; 35:E917-20. [PMID: 21381257 DOI: 10.1097/brs.0b013e3181ddfb24] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report and a discussion of recent published data. OBJECTIVE To highlight the importance of vertebral hemangioma (VH) as a differential diagnosis in the evaluation of locally aggressive spinal lesions. SUMMARY OF BACKGROUND DATA VH commonly occur as incidental findings, however, locally aggressive VH have been described. Difficulties in diagnosing these lesions are well reported and relate to changes in fat content causing uncharacteristic appearances on imaging. The management options for these lesions include a combination of observation, embolization, sclerotherapy, surgical decompression, or stabilization and radiotherapy. METHODS A 45-year-old patient who was previously well presented with back pain and rapidly progressive paraparesis. Imaging confirmed the presence of an extensive lesion centered within the right T3 vertebral pedicle with intrusion into the spinal canal. Urgent surgical decompression was undertaken and was complicated by extensive intraoperative hemorrhage requiring massive transfusion. RESULTS Histologically, the lesion was shown to be a cavernous VH with no evidence of malignancy. Following radiation oncology review, he was offered adjuvant radiotherapy to minimize the risks of recurrence. He achieved a near full neurologic recovery within 2 weeks and had a full recovery by 12 months. CONCLUSION VH should be considered in the evaluation of locally aggressive spinal lesions. Angiography is a useful adjunct in the evaluation of these lesions, both as a diagnostic and therapeutic tool. After diagnosed correctly a wide range of treatment options exist that may prevent the patient from undergoing major surgical resection and reconstruction procedures, which may be associated with high rates of morbidity.
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Heyd R, Seegenschmiedt MH, Rades D, Winkler C, Eich HT, Bruns F, Gosheger G, Willich N, Micke O. [The significance of radiation therapy for symptomatic vertebral hemangiomas (SVH)]. Strahlenther Onkol 2010; 186:430-5. [PMID: 20803283 DOI: 10.1007/s00066-010-2140-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 03/05/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the efficacy of radiation therapy (RT) for symptomatic vertebral hemangioma (SVH). MATERIAL AND METHODS Based on the Registry for Rare Benign Disorders (RRBD) of the German Cooperative Group on Radiation Therapy for Benign Diseases (GCG-BD), the clinical information, treatment plans and outcome data from seven cooperating German RT institutions were analyzed retrospectively. RESULTS Over a period of 39 years (1969-2008), a total of 84 patients with 96 symptomatic lesions underwent RT. The predominant indication was pain in 97.6%, and, in addition, 28.6% of patients had neurological deficits. The median total dose was 34 Gy (4.5-45 Gy), and the median single dose 2.0 Gy (0.5-3.0 Gy). After a median follow-up of 68 months (6-422 months), complete symptom relief (CR) occurred in 61.9% of patients, 28.6% had partial relief, and 9.5% had no relief (NR). The overall response rate (CR + PR) was 90.5%. In 26.2% of patients, radiologic signs of remineralization were noted. After a median follow-up of 70 months (8-124 months), symptom progression occurred in eight patients (9.5%). Therefore, the long-term rate of local control was 80.9%. Multivariate statistical analysis revealed a significantly higher rate of symptom relief and local control for total doses > or = 34 Gy. Side effects > RTOG/EORTC grade 2 were not observed. CONCLUSION RT is a safe and effective for treatment of SVH. Total doses of at least 34 Gy are recommended to achieve optimal treatment response.
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Affiliation(s)
- Reinhard Heyd
- Strahlenklinik, Klinikum Offenbach, Offenbach, Germany.
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147
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Management of symptomatic vertebral haemangioma in a resource challenged environment. Childs Nerv Syst 2010; 26:979-82. [PMID: 20217099 DOI: 10.1007/s00381-010-1101-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 01/29/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Vertebral haemangiomas are benign lesions and often asymptomatic. They are more common in the thoracic spine where they may become symptomatic with varying presentations. CASE REPORTS We present two teenage girls who presented with progressive, nontraumatic paraparesis with no background history of chronic cough or underlying medical illness. DISCUSSION The radiologic investigations were suggestive of vertebral haemangiomas of the thoracic spine. They had surgery: transthoracic approach with corpectomy and fusion with iliac crest autograft. The posterior stabilisation in the first patient was with Rush nails and circlage wire and only circlage wire in the second patient. The first patient's post-operative recovery was complicated by graft extrusion necessitating re-opening thoracotomy and graft replacement. They are, however, both ambulant at discharge and have remained so 13 and 15 months post-surgery. CONCLUSION We have presented two cases with rewarding outcomes in the face of 'adaptive' instrumentation due to limited resources.
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Kurimoto M, Noguchi K, Nagai S, Asahi T, Kuwayama N, Hayashi N, Endo S. Thoracic vertebral cavernous hemangioma in a schizophrenic patient--case report. Neurol Med Chir (Tokyo) 2010; 50:485-7. [PMID: 20587975 DOI: 10.2176/nmc.50.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 55-year-old man presented with gait disturbance, incontinence, and back pain. He had a medical history of schizophrenia for the past 35 years. Computed tomography (CT) and magnetic resonance imaging suggested thoracic vertebral hemangioma. Dynamic CT incidentally detected a hepatic hemangioma. Laminectomy of T3 and T4, resection of the epidural hemangioma, and rigid instrumentation between T1 and T6 using rod and hook systems were performed. Postoperatively, his symptoms completely disappeared and the histological diagnosis was capillary hemangioma. Schizophrenic patients have diminished sensitivity to pain or other symptoms, so neurological symptoms may become severe. However, early and appropriate treatment can result in satisfactory neurological outcome. The patient had a rare association of vertebral hemangioma and hepatic hemangioma, which may be a chance occurrence.
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Al Barbarawi M, Odat Z, Alheis M, Qudsieh S, Qudsieh T. Surgical resection of neoplastic cervical spine lesions in relation to the vertebral artery V2 segment. Neurol Int 2010; 2:e11. [PMID: 21577335 PMCID: PMC3093210 DOI: 10.4081/ni.2010.e11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 04/16/2010] [Accepted: 05/05/2010] [Indexed: 11/23/2022] Open
Abstract
Neoplastic cervical spine lesions are seen infrequently by the spinal surgeon. The surgical management of these tumors, particularly with associated neurovascular compromise, is challenging in terms of achieving proper resection and spinal stabilization and ensuring no subsequent recurrence or failure of fixation. In this report we highlight some of the problems encountered in the surgical management of tumors involving the cervical spine with techniques applied for gross total resection of the tumor without compromising the vertebral arteries. Ten patients with neoplastic cervical spine lesions were managed in our study. The common cardinal presentation was neck and arm pain with progressive cervical radiculo-myelopathy. All patients had plain X-rays, computer tomography scans, and magnetic resonance imaging of the cervical spine. Digital subtraction or magnetic resonance angiograms were performed on both vertebral arteries when the pathology was found to be in proximity to the vertebral artery. When a tumor blush with feeders was evident, endovascular embolization to minimize intraoperative bleeding was also considered. A single approach or a combined anterior cervical approach for corpectomy and cage-with-plate fixation and posterior decompression for resection of the rest of the tumor with spinal fixation was then accomplished as indicated. All cases made a good neurological recovery and had no neural or vascular complications. On the long-term follow-up of the survivors there was no local recurrence or surgical failure. Only three patients died: two from the primary malignancy and one from pulmonary embolism. This report documents a safe and reliable way to deal with neoplastic cervical spine lesions in proximity to vertebral arteries with preservation of both arteries.
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Affiliation(s)
| | | | - Mwaffaq Alheis
- Department of Radiology, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Suhair Qudsieh
- Hashemite University, Faculty of Medicine, Zarqa, Jordan
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