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Kesavapisharady K, Divakar G, George T, E R J, Venkat Hariharan E. Compressive vertebral hemangiomas with neurological deficits: diagnosis, surgical strategies and long term outcome. Br J Neurosurg 2024; 38:735-745. [PMID: 34435527 DOI: 10.1080/02688697.2021.1967878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/29/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Compressive vertebral hemangiomas with neurological deficits (CVHND) form a rare, unique subset of lesions comprising of differing clinico-imaging findings, pathologic behavior and treatment, when compared to the commoner and usually incidental intra-osseus vertebral hemangiomas (VH). Though various surgical strategies and a broad array of adjuncts have evolved and changed over the years, there is paucity of comprehensive data from sizeable series of such patients treated surgically with long term follow up. The purpose of this study is to device an optimum management strategy in CVHND based on our surgical experience. MATERIALS AND METHODS The data from electronic medical records of 26 consecutive patients operated in our department from 2009 to 2019 were retrospectively analyzed. RESULTS There were 11 males and 15 females with a mean age of 34.7 years. Neurological examination revealed paraparesis or paraplegia with myelopathy in all patients with Frankel score of B, C and D in 1 (3.9%), 11 (42.3%) and 14 (53.8%) patients respectively. Sixteen patients (61%) underwent laminectomy and gross total excision of extradural soft tissue component, 7 (27%) laminectomy with posterolateral fusion, three (12%) underwent additional anterior interbody support. The mean follow up was 72.4 months and at last follow-up 24 patients (92%) were Frankel E. Symptomatic recurrence was seen in two patients operated early in the series, they underwent re-surgery, gross total excision with posterolateral fusion, remaining neurologically intact at last follow up. CONCLUSIONS Pre-operative embolization, surgical excision of extradural component and intra-operative vertebroplasty form the mainstay of treatment for CVHND. Instrumented posterolateral fusion with optional anterior interbody support accomplished through the same approach is required only in a minority of cases. The long-term outcome following timely and appropriate treatment is excellent. Anterior or anterolateral approaches for intervertebral support and radical procedures like total en-bloc spondylectomy (TES) are not usually required.
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Affiliation(s)
- Krishnakumar Kesavapisharady
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Ganesh Divakar
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Tobin George
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Jayadevan E R
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Easwer Venkat Hariharan
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
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Gagliardo T, Pagano TB, Piparo SL, Bifara V, Bono F, Ruffino S, Cinti F. Vertebral Angiomatosis in a Dog. J Am Anim Hosp Assoc 2024; 60:36-39. [PMID: 38175977 DOI: 10.5326/jaaha-ms-7384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 01/06/2024]
Abstract
A 3 yr old spayed female Cavalier King Charles spaniel was referred for insidious ataxia and paraparesis. A thoracolumbar lesion was suspected. Computed tomography showed focal osteolysis of the vertebral body and pedicles of T5. In addition, a hyperdense, extradural material within the vertebral canal, causing spinal cord compression on the right side, was present. The lesion was confirmed with magnetic resonance imaging. A T4-T5 hemi-dorsal laminectomy was performed to decompress the spinal cord. Histopathological examination was consistent with vertebral angiomatosis. After the surgery, the dog rapidly improved; however, 5 mo later the clinical signs relapsed. Vertebral angiomatosis is a vasoproliferative disorder, rarely reported as a cause of myelopathy in cats. This condition has not previously been reported in dogs. This case report describes the clinical features, the diagnostic findings, and the follow-up of a young dog with vertebral angiomatosis.
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Affiliation(s)
- Teresa Gagliardo
- From Diagnostic Veterinary Center PalermoVet, Palermo, Italy (T.G., S.L.P., V.B., F.B., S.R.)
| | - Teresa Bruna Pagano
- Laboratorio di Analisi Veterinarie MYLAV s.r.l., Rho (Milan), Italy (T.B.P.); and
| | - Silvana Lo Piparo
- From Diagnostic Veterinary Center PalermoVet, Palermo, Italy (T.G., S.L.P., V.B., F.B., S.R.)
| | - Veronica Bifara
- From Diagnostic Veterinary Center PalermoVet, Palermo, Italy (T.G., S.L.P., V.B., F.B., S.R.)
| | - Filena Bono
- From Diagnostic Veterinary Center PalermoVet, Palermo, Italy (T.G., S.L.P., V.B., F.B., S.R.)
| | - Salvatore Ruffino
- From Diagnostic Veterinary Center PalermoVet, Palermo, Italy (T.G., S.L.P., V.B., F.B., S.R.)
| | - Filippo Cinti
- Surgery Department, San Marco Veterinary Clinic and Laboratory, Veggiano, Italy (F.C.)
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Chalamgari A, Valle D, Palau Villarreal X, Foreman M, Liu A, Patel A, Dave A, Lucke-Wold B. Vertebral Primary Bone Lesions: Review of Management Options. Curr Oncol 2023; 30:3064-3078. [PMID: 36975445 PMCID: PMC10047554 DOI: 10.3390/curroncol30030232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/26/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
The assessment and treatment of vertebral primary bone lesions continue to pose a unique yet significant challenge. Indeed, there exists little in the literature in the way of compiling and overviewing the various types of vertebral lesions, which can often have complicated intervention strategies. Given the severe consequences of mismanaged vertebral bone tumors-including the extreme loss of motor function-it is clear that such an overview of spinal lesion care is needed. Thus, in the following paper, we aim to address the assessment of various vertebral primary bone lesions, outlining the relevant nonsurgical and surgical interventional methods. We describe examples of primary benign and malignant tumors, comparing and contrasting their differences. We also highlight emerging treatments and approaches for these tumors, like cryoablation and stereotactic body radiation therapy. Ultimately, we aim to emphasize the need for further guidelines in regard to correlating lesion type with proper therapy, underscoring the innate diversity of vertebral primary bone lesions in the literature.
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Affiliation(s)
| | | | | | | | | | | | | | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL 32601, USA
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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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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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LUZ LUCASXAVIERDA, SIMÕES MARCELOSIMONI, OLIVEIRA BRUNODEAZEVEDO, MIOTTO GUILHERMEJOSÉ, ABREU ERNANIVIANNADE. AGGRESSIVE VERTEBRAL HEMANGIOMAS – CASE SERIES AND LITERATURE REVIEW. COLUNA/COLUMNA 2020. [DOI: 10.1590/s1808-185120201904223670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objectives To present a series of aggressive hemangiomas of the institution, with a review of the management options described in the literature. Methods This is a retrospective survey of aggressive vertebral hemangiomas treated by the service in the last 10 years, with histological confirmation of the diagnosis and a minimum follow-up of 1 year. The case analysis and literature review were conducted with emphasis on treatment options for these injuries. Results Seven cases were found, three with pain and four with severe neurological deficits. Two patients were treated with open decompression, one with open decompression and cementation, one with open decompression and arthrodesis, one with biopsy and cementation, one with percutaneous biopsy, and one with open biopsy followed by decompression surgery. All patients underwent radiotherapy. There was a significant regression of presentation deficits, but one patient developed an irreversible deficit during treatment. There were no recurrences or late complications in the follow-up period. Conclusions Surgical decompression in patients with significant neurological deficit is a point of consensus in the literature. Subtotal resection followed by radiation therapy was effective in treating deficits and controlling pathology. Cases manifesting pain only can be managed with minimally invasive techniques, whether or not they are followed by radiotherapy. Level of evidence IV; Therapeutic study of case series.
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Giorgi P, Compagnone D, Gallazzi E, Schirò GR. Early percutaneous treatment of an aggressive vertebral hemangioma: A case report with a 5-year follow-up. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:139-142. [PMID: 32904814 PMCID: PMC7462142 DOI: 10.4103/jcvjs.jcvjs_31_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/03/2020] [Indexed: 11/24/2022] Open
Abstract
Vertebral hemangiomas (VHs) are very common radiological findings, and the majority of them are completely asymptomatic and harmless. However, although rarely, they can present as locally aggressive, symptomatic lesions, and requiring surgery. In these cases, early diagnosis and treatment are mandatory to avoid serious complications and invasive surgery; however, there is no consensus about the best therapeutic option. Minimally-invasive percutaneous techniques have recently gained interests as a therapeutic option. A case of a 58-year-old male with a symptomatic aggressive VH of L5 presenting with untractable low back and radicular pain without neurological deficits is reported. An early percutaneous procedure with selective embolization combined with biportal kyphoplasty of L5 was performed. No complications and a very low-intraoperative bleeding were reported. The patient has been monitored for the following 5 years with a good outcome and with no signs of recurrence. This case report highlights the importance of making the right diagnosis and the advantages of an early percutaneous treatment with selective embolization and augmentation to avoid major open surgery with high risks.
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Affiliation(s)
- Pietro Giorgi
- Orthopaedic and Traumatology Division, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Domenico Compagnone
- Residency Program in Orthopaedics and Traumatology, University of Milan, Milan, Italy
| | - Enrico Gallazzi
- Orthopaedic and Traumatology Division, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppe Rosario Schirò
- Orthopaedic and Traumatology Division, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Corniola MV, Schonauer C, Bernava G, Machi P, Yilmaz H, Lemée JM, Tessitore E. Thoracic aggressive vertebral hemangiomas: multidisciplinary management in a hybrid room. 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 2020; 29:3179-3186. [PMID: 32277334 DOI: 10.1007/s00586-020-06404-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/25/2020] [Accepted: 03/30/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Vertebral hemangiomas (VH) account for 2-3% of all spinal tumors. The majority is incidentally found on radiographic studies: 1% present with pain and/or neurologic deficits. We report our experience with the multidisciplinary management of aggressive symptomatic thoracic VH by concomitant intraoperative sclerotization with sodium tetradecyl sulfate (STS), vertebroplasty, posterior decompression (with/without fusion) and surgical resection in a hybrid operating room (HR) equipped with a rotational scanner and a radiolucent operating table. METHODS Patients admitted with aggressive spinal VH between 2007 and 2018 were included. Data regarding demographics, presenting symptoms, location of the lesion, preoperative embolization, length of the surgery, estimated blood loss (EBL) as well as follow-up (FU) were retrieved. RESULTS Five patients were included (three females, mean age 65 years; range 59-75). Three patients presented with a myelopathy and two mechanical thoracic pain. All patients underwent a single-stage percutaneous sclerotization and vertebroplasty followed by a surgical decompression associated with epidural intralesional injection of STS and subtotal resection of the epidural lesion. Two patients had preoperative embolization. Mean procedural duration was 338 min (range 210-480 min). Four patients had marginal EBL, one patient had 500 ml EBL. Patients had no evidence of lesion recurrence or progression at the end of the follow-up. CONCLUSIONS The single-stage multimodal management of aggressive symptomatic VH is safe and effective. It allows for a direct intraoperative sclerotherapy combined with maximal tumor resection, resulting in reduced blood loss. The use of STS as a direct intraoperative sclerotizing agent is safe and reliable.
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Affiliation(s)
- Marco V Corniola
- Spine Unit, Département Des Neurosciences Cliniques, Service de Neurochirurgie, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Claudio Schonauer
- Neurosurgical Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Gianmarco Bernava
- Neuroradiology Unit, Department of Radiology, Geneva University Hospitals, Geneva, Switzerland
| | - Paolo Machi
- Neuroradiology Unit, Department of Radiology, Geneva University Hospitals, Geneva, Switzerland
| | - Hasan Yilmaz
- Neuroradiology Unit, Department of Radiology, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Michel Lemée
- Spine Unit, Département Des Neurosciences Cliniques, Service de Neurochirurgie, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Enrico Tessitore
- Spine Unit, Département Des Neurosciences Cliniques, Service de Neurochirurgie, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
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Xu W, Lan Z, Huang Y. Intraoperative injection of absorbable gelatin sponge (AGS) mixed with cement followed by spinal decompression to treat elderly with vertebral hemangiomas. BMC Musculoskelet Disord 2020; 21:125. [PMID: 32093675 PMCID: PMC7041297 DOI: 10.1186/s12891-020-3143-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 02/17/2020] [Indexed: 12/01/2022] Open
Abstract
Background Elderly patients with vertebral hemangiomas are rare and might require surgery. Thus, the choice of surgery for these lesions remains controversial because of the rarity of these lesions. This study aimed to analyze the clinical efficacy of the intraoperative injection of absorbable gelatin sponge mixed with cement followed by spinal decompression to treat the elderly with typical vertebral hemangiomas. The risk factors for hemangioma recurrence were investigated through a literature review. Methods We retrospectively analyzed 13 patients with typical aggressive hemangiomas between January 2009 and January 2016. Of these patients, 7 were treated with spinal decompression combined with intraoperative vertebroplasty (Group A), and 6 patients were treated with decompression with intraoperative vertebroplasty and absorbable gelatin sponge (Group B). The general data and perioperative data of the patients were compared. Patients were followed up for at least 3 years, and postoperative complications and recurrence rates were recorded and compared. Results All patients had typical aggressive hemangiomas. The average age of all patients was 64.4 ± 3.3 years. The preoperative data did not differ significantly between the two groups (P > 0.05). The blood loss of groups A and B was 707.1 ± 109.7 ml and 416.7 ± 103.3 ml, respectively (P = 0.003) (P = 0.003), and the average surgery durations were 222 ± 47.8 min and 162 ± 30.2 min, respectively (P = 0.022). The average follow-up duration was 62 ± 19 months, and no cases of recurrence were found at the final follow-up assessment. Conclusions Multimodal treatment significantly alleviated the clinical symptoms of elderly patients with typical aggressive vertebral hemangiomas. Intraoperative absorbable gelatin sponge injection is a safe and effective way to reduce blood loss and surgery duration.
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Affiliation(s)
- Weihong Xu
- Department of Spine Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Zhibin Lan
- Department of Spine Surgery, Quanzhou Orthopedic-Traumatological Hospital of Fujian Traditional Chinese Medicine University, Quanzhou, 362000, Fujian, China
| | - Yuming Huang
- The Orthopedics Department, Fuzhou Second Hospital affiliated to Xiamen University, Cangshan District, Fuzhou, 350007, Fujian, China.
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Fernández-Fernández J, Real-Noval H. Vertebral hemangiomatosis as atipic cause of acute myelopathy. Med Clin (Barc) 2019; 152:e63-e64. [PMID: 30470444 DOI: 10.1016/j.medcli.2018.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/18/2018] [Accepted: 09/27/2018] [Indexed: 10/27/2022]
Affiliation(s)
| | - Héctor Real-Noval
- Servicio de Cirugía, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
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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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Long-term outcome of treatment of vertebral body hemangiomas with direct ethanol injection and short-segment stabilization. Spine J 2019; 19:131-143. [PMID: 29890263 DOI: 10.1016/j.spinee.2018.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/13/2018] [Accepted: 05/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Vertebral body hemangiomas with myelopathy are difficult to manage. OBJECTIVE The objective of this study was to evaluate the role of intraoperative ethanol embolization, surgical decompression, and instrumented short-segment fusion in vertebral hemangioma (VH) with myelopathy and long-term outcome (>24 months). CLINICAL MATERIALS AND METHODS This prospective study included symptomatic VH with cord compression with myelopathy. Pathologic fractures and deformity or multilevel pathologies were excluded from the study. Surgery consisted of intraoperative bilateral pedicular absolute alcohol (<1% hydrated ethyl alcohol) injection, laminectomy, and cord decompression at the level of pathology followed by a short-segment instrumented fusion using pedicle screws. RESULTS The study included 33 patients (mean 26.9±13.2, range: 10-68 years, 18 females). The clinical features of the study were myelopathy in all patients (5 paraplegic), sphincter involvement (13), and mid back or lower back pain (7). The preoperative American Spinal Injury Association (ASIA) scores were A (7), B (11), C (6), D (8), and E (1). Majority of the patients had single vertebral involvement (30) and three patients had multiple-level involvement. Six patients underwent surgery earlier (one underwent alcohol embolization). The mean surgical time was 124±39 minutes, and the average blood loss was 274±80 cc. The mean amount of absolute alcohol injected was 14.6±5.7 cc (two patients required 20 and 25 cc). Immediate embolization was achieved in all patients, allowing laminectomy and easy removal of soft-tissue hemangioma. Post surgery, one patient had transient deterioration, and the condition of the rest of the patients improved (sphincters improved in nine patients) at a follow-up ranging 28-103 months (mean 47.6±22.3). Follow-up ASIA scores were E (26), D (4), B (2), and C (1). All patients showed evidence of bone sclerosis and relief of cord compression on follow-up imaging. CONCLUSIONS This is the largest study in literature showing excellent improvement, low reoperation rates after ethanol embolization, and short-segment fixation.
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Vertebral Hemangioma. Neuroradiology 2019. [DOI: 10.1016/b978-0-323-44549-8.00029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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14
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Hans EC, Dudley RM, Watson AT, Chalkley M, Foss KD, Bancroft A, Prescott DM. Long-term outcome following surgical and radiation treatment of vertebral angiomatosis in a cat. J Am Vet Med Assoc 2018; 253:1604-1609. [DOI: 10.2460/javma.253.12.1604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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15
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Wang B, Meng N, Zhuang H, Han S, Yang S, Jiang L, Wei F, Liu X, Liu Z. The Role of Radiotherapy and Surgery in the Management of Aggressive Vertebral Hemangioma: A Retrospective Study of 20 Patients. Med Sci Monit 2018; 24:6840-6850. [PMID: 30259906 PMCID: PMC6180950 DOI: 10.12659/msm.910439] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Vertebral hemangioma is usually a benign and asymptomatic tumor of blood vessels, but can be aggressive (symptomatic) with expansion, pain, and spinal cord compression. The aim of this study was to review the effects of radiotherapy, surgery, and other treatment approaches in patients with aggressive vertebral hemangioma. Material/Methods Retrospective clinical review included 20 patients who underwent radiotherapy as their first-line treatment for aggressive vertebral hemangioma with mild or slowly developing neurological deficit. External radiation was divided into 20–25 fractions with a total dose of 40–50 Gy. Minimum clinical follow-up after treatment was 20 months. Results The 20 patients included eight men and 12 women (mean age, 46.6 years), with aggressive vertebral hemangioma located in the cervical, thoracic, and lumbar vertebrae in four, 14, and two patients, respectively. Following radiotherapy treatment, 65.0% of patients (13/20) were symptom-free, without recurrence or malignant transformation at the time of last clinical follow-up (average, 75.2 months). Due to minor post-radiation vertebral re-ossification, two of the 13 patients who were initially symptom-free after radiotherapy requested percutaneous vertebroplasty. A further seven patients required surgery after radiotherapy, due to increasing neurological deficit in three patients, and persistent neurological deficit in four patients. At the last follow-up (average, 63.6 months), six patients were symptom-free, and one patient still had slight residual symptoms. Conclusions Radiotherapy was a safe and effective treatment choice for aggressive vertebral hemangioma, but in case with severe spinal cord compression and neurological deficit, surgical intervention was required.
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Affiliation(s)
- Ben Wang
- Department of Orthopaedic, Peking University Third Hospital, Beijing, China (mainland).,Peking University Health and Science Center, Beijing, China (mainland)
| | - Na Meng
- Department of Radiotherapy, Peking University Third Hospital, Beijing, China (mainland)
| | - Hongqing Zhuang
- Department of Radiotherapy, Peking University Third Hospital, Beijing, China (mainland)
| | - Songbo Han
- Department of Radiology, Peking University Third Hospital, Beijing, China (mainland)
| | - Shaomin Yang
- Department of Pathology, Peking University Third Hospital, Beijing, China (mainland)
| | - Liang Jiang
- Department of Orthopaedic, Peking University Third Hospital, Beijing, China (mainland)
| | - Feng Wei
- Department of Orthopaedic, Peking University Third Hospital, Beijing, China (mainland)
| | - Xiaoguang Liu
- Department of Orthopaedic, Peking University Third Hospital, Beijing, China (mainland)
| | - Zhongjun Liu
- Department of Orthopaedic, Peking University Third Hospital, Beijing, China (mainland)
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Nigro L, Donnarumma P. Vertebral hemangiomas: common lesions with still many unknown aspects. JOURNAL OF SPINE SURGERY 2017; 3:309-311. [PMID: 28744519 DOI: 10.21037/jss.2017.05.11] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lorenzo Nigro
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Pasquale Donnarumma
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
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Abstract
Hemangiomas are benign tumors, which are mainly composed of neoplastic blood vessels. The exact pathogenesis is still unclear. They are the most common benign spinal tumors and also occur less commonly in the bones of the extremities. Hemangiomas are often clinically asymptomatic and are diagnosed as incidental findings. Women are affected more frequently than men (2:1). The X‑ray and computed tomography (CT) diagnostics typically demonstrate the classical honeycombing or vertically orientated lucencies separated by thickened cancellous bone in the affected skeletal section. Vertebral hemangiomas are hyperintense in both T1 and T2-weighted magnetic resonance imaging (MRI). The treatment of vertebral hemangiomas ranges from irradiation, embolization and vertebroplasty to operative decompression, resection of the tumor and instrumented stabilization. In the long bones intralesional curettage and bone grafting with additive osteosynthesis is the main treatment modality. The prognosis for osseous hemangiomas is good.
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Affiliation(s)
- M Rickert
- Orthopädische Universitätsklinik Friedrichsheim gGmbH, Marienburgstr. 2, 60528, Frankfurt am Main, Deutschland.
| | - A Meurer
- Orthopädische Universitätsklinik Friedrichsheim gGmbH, Marienburgstr. 2, 60528, Frankfurt am Main, Deutschland
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Nigro L. Letter to the Editor: Aggressive vertebral hemangiomas. Neurosurg Focus 2016; 41:E12. [PMID: 27798983 DOI: 10.3171/2016.8.focus16334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Alfawareh M, Alotaibi T, Labeeb A, Audat Z. A Symptomatic Case of Thoracic Vertebral Hemangioma Causing Lower Limb Spastic Paresis. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:805-809. [PMID: 27795545 PMCID: PMC5088736 DOI: 10.12659/ajcr.898562] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Patient: Male, 18 Final Diagnosis: Hemangioma Symptoms: Pain • weaknes of lower limbs Medication: — Clinical Procedure: Decompression and fixation Specialty: Neurosurgery
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Affiliation(s)
| | - Tariq Alotaibi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdallah Labeeb
- Spine Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ziad Audat
- Spine Department, King Abdullah University, Irbid, Jordan
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