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Sekar A, Datta D, Parameshwar, Gulla KM, Bansal S. Aggressive vertebral hemangiomas in children. Childs Nerv Syst 2023; 39:571-575. [PMID: 36416953 DOI: 10.1007/s00381-022-05760-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Aggressive vertebral hemangiomas are rare tumors in children, usually occurring in the thoracic spine that can cause significant neurological morbidity. They are technically difficult to treat with significant risk of blood loss during surgery. METHODS We describe a case of aggressive vertebral hemangioma managed in our institution. We performed a literature review of reported cases of aggressive vertebral hemangiomas in pediatric age group. We discuss the clinical presentation, diagnosis, and management of these lesions. RESULTS We identified 23 cases of aggressive vertebral reported in children. Neurodeficit was the most common presentation, and the most common location was the thoracic spine. Surgery was the most common modality of treatment. All the patients reported in literature had improvement in their symptoms after treatment. CONCLUSION Although technically challenging, aggressive vertebral hemangiomas have a good outcome after treatment. Treatment should be tailored to the individual patient. Further studies are needed to determine the optimum treatment strategy.
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Affiliation(s)
- Arunkumar Sekar
- Department of Neurosurgery, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Odisha, 751019, India.
| | - Debajyoti Datta
- Department of Neurosurgery, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Parameshwar
- Department of Neurosurgery, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Krishna Mohan Gulla
- Department of Pediatrics, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Sumit Bansal
- Department of Neurosurgery, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Odisha, 751019, India
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Uysal B, Gamsiz H, Dincoglan F, Sager O, Demiral S, Dirican B, Beyzadeoglu M. Single-center outcomes of image-guided radiotherapy in the management of vertebral hemangioma with daily kilovoltage cone-beam computerized tomography. J Cancer Res Ther 2021; 17:1521-1524. [PMID: 34916388 DOI: 10.4103/jcrt.jcrt_133_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Vertebral hemangiomas are defined as benign proliferation of blood vessels. Vertebral hemangiomas are generally found incidentally by computerized tomography or magnetic resonance imaging; however, they may also cause pain and quality-of-life impairment in some circumstances with reference to their location and association with the spinal cord. In this study, we assessed the utility of image-guided radiation therapy (IGRT) in the management of patients with painful vertebral hemangioma. Materials and Methods Patients receiving IGRT for the management of painful vertebral hemangioma were evaluated. The total dose was 24 Gy delivered in 12 daily fractions. The verbal numeric scale (VNS) was used for the assessment of pain relief. The median follow-up duration was 13 months (range: 6-24 months). Results Median preradiotherapy VNS score was 8 (range: 6-10) and median postradiotherapy VNS score was 1 (range: 0-2) for the total 135 patients treated with IGRT at our department for painful vertebral hemangioma. Reduction in VNS scores after IGRT was statistically significant (P < 0.05). Conclusion Our single-center study revealed that IGRT resulted in substantial relief of pain from vertebral hemangioma. Randomized prospective multicenter trials are needed to shed light on the optimal management of patients suffering from pain due to vertebral hemangioma.
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Affiliation(s)
- Bora Uysal
- Department of Radiation Oncology, Gulhane Training and Research Hospital, University of Health Sciences, Kecioren, Ankara, Turkey
| | - Hakan Gamsiz
- Department of Radiation Oncology, Gulhane Training and Research Hospital, University of Health Sciences, Kecioren, Ankara, Turkey
| | - Ferrat Dincoglan
- Department of Radiation Oncology, Gulhane Training and Research Hospital, University of Health Sciences, Kecioren, Ankara, Turkey
| | - Omer Sager
- Department of Radiation Oncology, Gulhane Training and Research Hospital, University of Health Sciences, Kecioren, Ankara, Turkey
| | - Selcuk Demiral
- Department of Radiation Oncology, Gulhane Training and Research Hospital, University of Health Sciences, Kecioren, Ankara, Turkey
| | - Bahar Dirican
- Department of Radiation Oncology, Gulhane Training and Research Hospital, University of Health Sciences, Kecioren, Ankara, Turkey
| | - Murat Beyzadeoglu
- Department of Radiation Oncology, Gulhane Training and Research Hospital, University of Health Sciences, Kecioren, Ankara, Turkey
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Brunette-Clément T, Weil AG, Shedid D. Total en bloc spondylectomy of locally aggressive vertebral hemangioma in a pediatric patient. Childs Nerv Syst 2021; 37:2115-2120. [PMID: 33130918 DOI: 10.1007/s00381-020-04954-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Vertebral hemangiomas are benign, highly vascular spinal lesions that are extremely rare in the pediatric population. We report a pediatric case of symptomatic vertebral hemangioma treated with total en bloc spondylectomy. Our objective is to demonstrate that en bloc spondylectomy is feasible and addresses some pitfalls of traditional total tumor resection. METHODS Our patient presented with bilateral lower limb and perineal paresthesia, paraparesis, as well as urinary retention. Locally aggressive vertebral hemangioma was the presumed diagnosis following imaging. The patient received partial angioembolization to reduce the vascularization of the lesion then underwent total en bloc spondylectomy of T8 under intraoperative neuromonitoring. The intervention was well tolerated. RESULTS Postoperative course was marked by clinical improvement and only transient, treatable complications. On 1-year follow-up, the patient is neurologically intact, and imaging reveals adequate position of hardware, good alignment, and no tumor recurrence. CONCLUSION Total en bloc spondylectomy is a feasible procedure in pediatric patients. It reduces local recurrence through reduction of tumor cell contamination and residual tumor and thus may avoid postoperative radiotherapy in select cases. It may also enhance functional neurological recovery by allowing circumferential decompression and increased spinal cord blood flow.
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Affiliation(s)
- Tristan Brunette-Clément
- Division of Neurosurgery, Sainte-Justine University Hospital Center, 3175, chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - Alexander G Weil
- Division of Neurosurgery, Sainte-Justine University Hospital Center, 3175, chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.
| | - Daniel Shedid
- Division of Neurosurgery, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
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Chopra H, Hoffman H, Richardson TE, Galgano MA. Surgical management of symptomatic vertebral hemangiomas: A case report and literature review. Surg Neurol Int 2021; 12:56. [PMID: 33654559 PMCID: PMC7911040 DOI: 10.25259/sni_752_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/18/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Vertebral hemangiomas (VHs) are common benign tumors that only rarely become symptomatic. There is a paucity of data regarding their surgical management and outcomes. Here, we reported a case involving an aggressive cervical VH, discussed its surgical management and outcomes, and reviewed the literature. Methods: We assessed the clinical, radiological, and surgical outcomes for a patient with an aggressive cervical VH. We also performed a systematic review of the literature according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to describe surgical outcomes for symptomatic VH. Results: A total of 154 studies including 535 patients with VH were included in the study. The majority of patients were female (62.8%), the average age was 43 years, and the thoracic spine was most commonly involved (80.6%). Utilizing Odom’s criteria, outcomes were excellent in 81.7% (95% CI 73.2–90.2) of cases. For those presenting with myelopathy (P = 0.045) or focal neurological deficits (P = 0.018), outcomes were less likely to be excellent. Preoperative embolization was not associated with excellent outcome (P = 0.328). Conclusion: Surgical outcomes for VH are predominantly favorable, but aggressive VHs have the potential to cause significant residual postoperative neurological morbidity.
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Affiliation(s)
- Harman Chopra
- Department of Neurosurgery, SUNY Upstate, Syracuse, New York, United States
| | - Haydn Hoffman
- Department of Neurosurgery, SUNY Upstate, Syracuse, New York, United States
| | | | - Michael A Galgano
- Department of Neurosurgery, SUNY Upstate, Syracuse, New York, United States
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Gajaseni P, Labianca L, Lacerda I, Weinstein S. A Child with a Rare Extraosseous Extension and Pathologic Fracture from a Vertebral Hemangioma: A Case Report. JBJS Case Connect 2019; 7:e86. [PMID: 29286970 DOI: 10.2106/jbjs.cc.17.00057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present a case of a pathologic vertebral fracture and encroachment into the spinal canal from a vertebral hemangioma in a 13-year-old boy. The original approach of embolization followed by an anterior-posterior resection and stabilization through a costotransversectomy had to be converted intraoperatively to a combined anterior and posterior approach secondary to excessive bleeding. CONCLUSION Because of the hypervascularity and the extensive nature of aggressive vertebral hemangiomas, surgeons attempting procedures similar to the case described herein must be prepared to adapt to the circumstances when preoperative embolization is not totally effective. Surgical technique, proper anesthesia, and patient clotting capacity are important factors to consider.
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Affiliation(s)
- Pawin Gajaseni
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,Department of Orthopedics, Phramongkutklao Hospital, Bangkok, Thailand
| | - Luca Labianca
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,Catholic University Sacro Cuore di Gesu, Fondazione Sovena, Rome, Italy
| | - Iara Lacerda
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Stuart Weinstein
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Wang B, Zhang L, Yang S, Han S, Jiang L, Wei F, Yuan H, Liu X, Liu Z. Atypical Radiographic Features of Aggressive Vertebral Hemangiomas. J Bone Joint Surg Am 2019; 101:979-986. [PMID: 31169574 DOI: 10.2106/jbjs.18.00746] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Vertebral hemangioma (VH) is one of the most common benign spinal tumors and can be aggressive in some cases. While most aggressive VHs have typical radiographic features, including vertical striations, a honeycomb appearance, and/or a "polka-dot sign" in computed tomography (CT) scans, cases with atypical features might complicate diagnosis. This study aimed to determine the range and frequency of these atypical features. METHODS In this retrospective study, to identify the typical and atypical features of aggressive VH, pretreatment CT and magnetic resonance imaging (MRI) were reviewed retrospectively by 1 radiologist and 1 orthopaedic surgeon. Percutaneous biopsies were performed to confirm the VH in atypical cases. RESULTS A total of 95 patients with aggressive VHs were treated in our hospital from January 2005 to December 2017. Thirty-four (36%) of the lesions showed at least 1 atypical radiographic feature: 16 patients (17%) had a vertebral compression fracture, 11 patients (12%) had expansive and/or osteolytic bone destruction without a honeycomb appearance and/or "polka-dot sign", 11 patients (12%) had obvious epidural osseous compression of the spinal cord, 12 patients (13%) had involvement of >1 segment, 9 patients (10%) had a VH centered in the pedicle and/or lamina, and 8 patients (8%) had atypical MRI signals. Forty-three patients underwent percutaneous biopsies, which had an accuracy of 86%. CONCLUSIONS Based on radiographic analysis, aggressive VH can be classified as typical or atypical. More than one-third of aggressive VH lesions may have at least 1 atypical feature. CT-guided biopsies are indicated for these atypical cases.
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Affiliation(s)
- Ben Wang
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China.,Department of Pathology (S.Y.), Peking University Health and Science Center (B.W.), Beijing, China
| | - Lihua Zhang
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Shaomin Yang
- Department of Pathology (S.Y.), Peking University Health and Science Center (B.W.), Beijing, China
| | - Songbo Han
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Liang Jiang
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Feng Wei
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Huishu Yuan
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Xiaoguang Liu
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Zhongjun Liu
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
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An ethical dilemma: how to treat a symptomatic pediatric vertebral hemangioma? CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Clinical Features and Prognostic Factors of Pediatric Spine Tumors: A Single-Center Experience With 190 Cases. Spine (Phila Pa 1976) 2016; 41:1006-1012. [PMID: 26987106 DOI: 10.1097/brs.0000000000001541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study was performed. OBJECTIVE The aim of the study was to illustrate the characteristics of pediatric spine tumors (PSTs) and obtain better insight into therapeutic strategies of such kinds of tumors. SUMMARY OF BACKGROUND DATA PSTs, a heterogeneous group of tumors occurred among pediatric group, are relatively uncommon and rarely reported in the literature. METHODS A retrospective study was performed to analyze clinical features and prognostic factors of patients with PSTs who were treated in our center between 2000 and 2013. Local relapse-free survival (LRFS) and overall survival (OS) rate were estimated using the Kaplan-Meier method to identify potential prognostic factors. Factors with P values of 0.1 or lower were subjected to multivariate analysis by Cox regression analysis. P values of 0.05 or lower were considered statistically significant. RESULTS A total of 190 patients with PSTs were included in the study. The mean follow-up period was 53.5 months. Of the 190 patients, 127 cases (66.8%) were diagnosed as benign lesions or tumor-like lesions, with 19 cases as aggressive lesions and 44 cases as malignant lesions. Recurrence was detected in 30 patients after initial surgery in our center, whereas death occurred in 24 cases. Implant failure and spinal deformity occurred in 3 and 5 patients, respectively. The statistical analysis suggested that multiple segments involvement (n ≥ 3), aggressive and malignant lesion were independent prognostic factors for LRFS, whereas malignant lesion was the only unfavorable factors for OS. In the subgroup analysis, multiple segments involvement (n ≥ 3) and Enneking stages III were independent factors for LRFS of patients with benign or aggressive lesions. CONCLUSION Malignant lesion was significantly associated with decreased OS and LRFS of PSTs, whereas multiple segments involvement (n ≥ 3) and aggressive lesions were significantly associated with LRFS. LEVEL OF EVIDENCE 4.
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Issa M, Lucas G, Violas P, Griffet J, Courvoisier A. Vertebroplasty for vertebral hemangioma in children: a report of two cases with 2-year follow-up. Childs Nerv Syst 2015; 31:2179-83. [PMID: 26070966 DOI: 10.1007/s00381-015-2777-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe two cases of a dorsal vertebral hemangioma diagnosed in a 12- and 14-year-old child successfully treated with vertebroplasty. METHOD Cases reports. RESULTS Two cases of aggressive vertebral hemangiomas were diagnosed and treated in two independent institutions. Percutaneous vertebroplasty was then decided. Bipedicular vertebroplasty was performed under general anesthesia, under biplanar fluoroscopic guidance. The injection of acrylic cement filled the entire vertebral body without significant leakage. At last follow-up, the clinical and radiographic outcome was very good. In one patient, last control radiographs showed a gap between the end plates and the cement, spinal growth seemed to have resumed. CONCLUSION Vertebral hemangioma is rare in pediatric patients, and its diagnosis requires meticulous and regular clinical examinations and a combination of imaging studies, particularly an MRI and a CT scan, which can assess the aggressiveness of the lesion. Vertebroplasty seems to be an effective and safe treatment of this benign tumor in children with stable outcome at 2-year follow-up. Spinal growth may resume despite the aggressiveness of both the tumor and the treatment.
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Affiliation(s)
- Majed Issa
- Pediatric Orthopedic Department, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | - Gregory Lucas
- Pediatric Orthopedic Department, Rennes University Hospital, Rennes, France
| | - Philippe Violas
- Pediatric Orthopedic Department, Rennes University Hospital, Rennes, France
| | - Jacques Griffet
- Pediatric Orthopedic Department, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | - Aurélien Courvoisier
- Pediatric Orthopedic Department, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France.
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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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