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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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Choudhary D, Mohan V, Varsha AS, Hegde A, Menon G. Neurosurgical emergencies during pregnancy - Management dilemmas. Surg Neurol Int 2023; 14:151. [PMID: 37151438 PMCID: PMC10159311 DOI: 10.25259/sni_1076_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Abstract
Background Neurosurgical emergencies in the obstetric setting pose considerable challenges. Decision-making involves deliberations on the gestational age, critical nature of the illness, timing of surgery, maternal positioning during neurosurgery, anesthesiologic strategies, monitoring of the pregnancy during surgery, and the mode of delivery. The present study discusses the management and ethical dilemmas encountered during the management of six obstetric patients with neurosurgical emergencies. Methods A retrospective review of all neurosurgical operations performed between January 2016 and December 2022 were included in the study. Results This study includes a series of six pregnant women who presented with neurosurgical emergencies, secondary to freshly diagnosed pathologies in the period 2016-2022. The mean maternal age was 31.33 years. Four of the six patients were in the third semester and two were in the second trimester. The underlying etiologies were as follows: spontaneous intracerebral hypertensive hemorrhage (1), obstructive hydrocephalus due to shunt malfunction (1), brain tumor (02), and compressive spinal cord myelopathy due to tumors (02). Three patients who were near term underwent lower cesarean section followed by emergency neurosurgical procedure in the same sitting. Two second trimester patients continued their pregnancy after the emergency neurosurgical operation. In one patient, in whom a brain tumor was diagnosed near term, underwent neurosurgery 1 week after successful cesarean section. All the six mothers and fetus recovered well, ex3cept two patients who have persisting residual deficits. Conclusion Treatment of neurosurgical emergencies during pregnancy needs to be customized depending on the clinical condition of the pregnant woman, prognosis of the disease, gestational age and the status of the pregnancy. With careful planning, timely intervention, consultative decision making and it is possible to achieve the ultimate goal - which is to protect and safeguard the mother and preserve and deliver a viable fetus.
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Affiliation(s)
| | | | | | | | - Girish Menon
- Corresponding author: Girish Menon, Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India.
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Xu D, Kong M, Zhu K, Han X, Zhang W, Zeng X, Zhou C, Ma X. Clinical evaluation of preoperative embolization, vertebroplasty, and decompression in the treatment of aggressive vertebral hemangiomas. J Orthop Surg (Hong Kong) 2021; 29:2309499021993997. [PMID: 33641539 DOI: 10.1177/2309499021993997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of preoperative embolization and vertebroplasty in the treatment of aggressive hemangioma. METHODS A retrospective clinical review of patients diagnosed with aggressive vertebral hemangiomas was conducted. All the patients were assigned to three groups according to the treatment strategies: patients in Group A underwent embolization and decompression with internal fixation, patients in Group B underwent vertebroplasty and decompression with internal fixation, patients in Group C received all three treatments. Clinical indexes were compared within three groups. RESULTS There were 16 patients received embolization and decompression (Group A), 19 patients underwent decompression with vertebroplasty (Group B) and 16 patients in Group C. The operative duration of patients in group A (198.33 ± 38.43 min) were less than another two groups (p = 0.001). The intraoperative blood loss of patients in group C was 713.33 ± 165.13 mL, which was significantly less than group A and group B (p = 0.045). Patients in group C exhibited the lowest volume of drainage on POD 1 (178.33 ± 66.76 mL), which showed significant difference compared with group A (368.33 ± 191.15 mL, p = 0.01). There was no significant difference of preoperative and postoperative VAS and JOA score among three groups, as well as drainage on POD 2, total volume and hospital duration. CONCLUSION Both embolization and vertebroplasty are efficient and safe measures to reduce blood loss in the surgical treatment of aggressive vertebral hemangiomas, combination of all three methods is also competent.
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Affiliation(s)
- Derong Xu
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.,Derong Xu and Meng Kong are co-first authors
| | - Meng Kong
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.,Derong Xu and Meng Kong are co-first authors
| | - Kai Zhu
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xing Han
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Wenwei Zhang
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xiangxu Zeng
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Chuanli Zhou
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xuexiao Ma
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
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Zhao L, Jiang Y, Wang Y, Bai Y, Sun Y, Li Y. Spinal Epidural Cavernous Hemangiomas: A Clinical Series of 9 Cases and Literature Review. Front Oncol 2021; 11:572313. [PMID: 33816222 PMCID: PMC8010302 DOI: 10.3389/fonc.2021.572313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Spinal epidural cavernous hemangiomas are very rare vascular lesions and are, therefore, seldom reported and easily misdiagnosed. Herein, we present a series of 9 cases with spinal epidural cavernous hemangiomas and discuss their pathogenesis, clinical characteristics, radiological findings, differential diagnosis, surgical interventions, pathological characteristics, and prognosis. Methods We retrospectively retrieved and analyzed the data of patients with pure epidural cavernous hemangiomas, who underwent spinal magnetic resonance imaging, and surgical intervention at the First Hospital of Jilin University, China, between January 2005 and December 2019. The data on patients’ clinical manifestations, imaging characteristics, surgical intervention, histopathological findings, and postoperative follow-up were also recorded and analyzed. Results In all, 5 men and 4 women with the mean age of 61 years (range, 41–78 years) were recruited. All patients experienced a gradual onset of symptoms and a slowly progressive clinical course, and no patient presented an acute onset of symptoms. The clinical manifestations include myelopathic signs in 8 patients (88.9%) and radicular symptoms in 3 patients (33.3%). On T1-weighted imaging, 6 lesions appeared isointense (55.6%), and 4 lesions exhibited hypointense (44.4%) signals. On T2-weighted imaging, 8 lesions appeared hyperintense (88.9%), and 1 lesion was heterogeneously intense (11.1%). Following gadolinium administration, 5 lesions appeared homogeneous with significant enhancement (55.6%), 1 lesion was homogeneous and mild enhancement (11.1%), and 3 lesions were heterogeneous with mild enhancement (33.3%). All patients received early microsurgery assisted by intraoperative electrophysiologic monitoring and neuronavigation in the lateral position via the posterior midline approach. Five patients underwent total laminectomy (55.6%), and 4 underwent hemilaminectomy (44.4%). Total excision was achieved in all cases. The average follow-up period was 55.1 months (ranging 10–123 months). All patients exhibited significant clinical improvement of their neurological deficits and achieved a favorable outcome with no recorded recurrence at last follow-up. Conclusions Spinal epidural cavernous hemangiomas are rare vascular malformations. Early surgical treatment with total resection is an optimum treatment, particularly for patients with an acute exacerbation onset. The prognosis is mostly good and depends predominantly on the severity of the preoperative status.
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Affiliation(s)
- Liyan Zhao
- Department of Clinical Laboratory, Second Hospital of Jilin University, Changchun, China
| | - Yining Jiang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yubo Wang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yang Bai
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Ying Sun
- Department of Clinical Laboratory, Second Hospital of Jilin University, Changchun, China
| | - Yunqian Li
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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Mariniello G, Pagano S, Meglio V, Barbato M, Russo C, Pontillo G, Di Stasi M, Elefante A. Multiple vertebral hemangiomas of the thoracic spine with atypical radiological features and aggressive behavior causing myelopathy: A case report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Gupta AK, Phukan P, Bodhey N. Percutaneous vertebroplasty for the treatment of symptomatic vertebral hemangioma with long-term follow-up. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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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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Thakar S, Sivaraju L, Ghosal N, Aryan S, Hegde AS. Fatal holocord recurrence of a pregnancy-related, low-grade spinal ependymoma: case report and review of an unusual clinical phenomenon. Spinal Cord Ser Cases 2020; 6:93. [PMID: 33009374 DOI: 10.1038/s41394-020-00343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Pregnancy-related spinal tumors (PRSTs) are unusual tumors that present during pregnancy or within a year after delivery. We describe a fatal holocord recurrence of a spinal ependymoma, which, to the best of our knowledge, is one of the most extensive PRSTs reported thus far. CASE PRESENTATION A 21-year-old primigravida presented at 6 months of gestation with urinary incontinence for 2 months and spastic paraparesis for 1 month. MRI showed a conus intramedullary lesion from T10 to 12. Near-total resection of the lesion was performed. The histopathological diagnosis was that of a cellular ependymoma (WHO grade II). The patient presented 6 months later with progressive quadriparesis and breathing difficulty. MRI demonstrated holocord recurrence of the tumor with edema extending to the pontomedullary junction. The patient succumbed to respiratory failure before decompression of the tumor could be performed. DISCUSSION This case highlights an unusual clinical course of a pregnancy-related, low-grade spinal ependymoma. The possible hormonal and genetic mechanisms underlying the aggressive involvement of the entire spinal cord by the recurrent tumor are discussed in the light of a literature review. Future studies may shed light on the possibility of utilizing these mechanisms as therapeutic targets to alter the clinical course of aggressive spinal ependymomas.
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Affiliation(s)
- Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore, Karnataka, 560066, India.
| | - Laxminadh Sivaraju
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore, Karnataka, 560066, India
| | - Nandita Ghosal
- Department of Pathology, Sri Sathya Sai Institute of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore, Karnataka, 560066, India
| | - Saritha Aryan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore, Karnataka, 560066, India
| | - Alangar S Hegde
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore, Karnataka, 560066, India
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Cazzato RL, Garnon J, De Marini P, Auloge P, Dalili D, Koch G, Antoni D, Barthelemy P, Kurtz JE, Malouf G, Feydy A, Charles YP, Gangi A. French Multidisciplinary Approach for the Treatment of MSK Tumors. Semin Musculoskelet Radiol 2020; 24:310-322. [DOI: 10.1055/s-0040-1710052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractSeveral interventional treatments have recently been integrated into the therapeutic armamentarium available for the treatment of bone tumors. In some scenarios (e.g., osteoid osteoma), interventional treatments represent the sole and definitive applied treatment. Due to the absence of widely shared protocols and the complex multivariate scenarios underlying the clinical presentation of the remaining bone tumors including metastases, therapeutic strategies derived from a multidisciplinary tumor board are essential to provide effective treatments tailored to each patient. In the present review, we present the multidisciplinary therapeutic strategies commonly adopted for the most frequent bone tumors.
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Affiliation(s)
- Roberto Luigi Cazzato
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julien Garnon
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierre De Marini
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierre Auloge
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Danoob Dalili
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Nuffield Orthopaedic Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Guillaume Koch
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Delphine Antoni
- Service de Radiothérapie, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Philippe Barthelemy
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Jean Emmanuel Kurtz
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Gabriel Malouf
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Antoine Feydy
- Service de Radiologie, Hôpital Cochin, APHP, Université Paris V, Paris, France
| | - Yan-Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Santagada DA, Perna A, Meluzio MC, Ciolli G, Proietti L, Tamburrelli FC. Symptomatic vertebral hemangioma during pregnancy period: A case series and systematic literature review. Orthop Rev (Pavia) 2020; 12:8685. [PMID: 32913613 PMCID: PMC7459382 DOI: 10.4081/or.2020.8685] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022] Open
Abstract
Vertebral Hemangioma (VH) is a benign tumor usually symptomless and discovered incidentally. Pregnancy, because of several hormonal and physiologic changes, is a recognized risk factor coinciding with the development of a rapid onset of neurological symptoms in patients affected by VH. In the Literature, sporadic cases of neurological symptoms have been described, which occurred during pregnancy, but only rarely the onset of symptoms was reported after pregnancy and childbirth. Usually surgical treatment is reserved for severe cases with rapid onset of neurological symptoms. However, the use of conservative treatments is still a topic of debate In the present study, we report a series of patients affected by VH become symptomatic during or after pregnancy along with a systematic review of the Literature.
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Affiliation(s)
- Domenico Alessandro Santagada
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Maria Concetta Meluzio
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Gianluca Ciolli
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Luca Proietti
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
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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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Wang GX, Mu YD, Che JY, Zhang GF, Jiang G, Gao CP. Compressive myelopathy and compression fracture of aggressive vertebral hemangioma after parturition: A case report and review of literature. Medicine (Baltimore) 2019; 98:e18285. [PMID: 31852104 PMCID: PMC6922397 DOI: 10.1097/md.0000000000018285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Compressive myelopathy and compression fracture of aggressive vertebral hemangioma after parturition is a rare condition. Vertebral body compression fracture and high serum progesterone lead to extraosseous hemangioma enlargment cause narrowing the spinal canal which contribute to compressive myelopathy relate to pregnancy. PATIENT CONCERNS We report a case of compressive myelopathy and compression fracture of aggressive vertebral hemangioma after parturition in a 35-year-old woman. The patient complained unable to walk and experienced intense pain in the back. DIAGNOSIS Based on the clinical features and imaging studies, the patient underwent a T4-T6 laminectomy. Histopathology consistent with vertebral hemangioma. INTERVENTIONS The patient underwent laminectomy for decompression. After subperiosteal dissection of the paraspinal muscles and exposure of the laminae, there was no involvement of the lamina by the tumor. The epidural tumor was removed through the spaces lateral to the thecal sac. Vertebroplasty was performed through T5 pedicles bilaterally and 7 ml of polymethylmethacrylate (PMMA) cement was injected. T4-T6 pedicle screw fixation was performed for segmental fixation and fusion. OUTCOMES Six months after resection of the tumor the patient remained asymptomatic. She reported no low back pain and had returned to her normal daily activities, with no radiographic evidence of recurrence on MRI. Physical examination revealed that superficial and deep sensation was restored to normal levels in the lower extremities. LESSONS The occurrence of compressive myelopathy of pregnancy related vertebral hemangiomas is quite unusual. It can lead to serious neurologic deficits if not treated immediately. So, prompt diagnosis is important in planning optimal therapy and preventing morbidity for patients.
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Affiliation(s)
- Guan-xi Wang
- Department of Radiology, Songshan Hospital of Qingdao University Medical College University
| | - Yuan-dong Mu
- Department of Radiology, Gaomi people Hospital, Weifang
| | - Jun-yi Che
- Department of Radiology, Qingdao Municipal Hospital
| | | | | | - Chuan-ping Gao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Gupta S, Singh S, Gogoi S, Das KK, Jaiswal AK. Impetuous expansion of pure epidural capillary hemangioma in pregnancy: A rare cause of acute paraplegia. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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15
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Wang B, Jiang L, Wei F, Liu XG, Liu ZJ. Progression of aggressive vertebral hemangiomas during pregnancy: Three case reports and literature review. Medicine (Baltimore) 2018; 97:e12724. [PMID: 30290682 PMCID: PMC6200486 DOI: 10.1097/md.0000000000012724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Vertebral hemangiomas (VHs), one of the most common benign tumors of the spine, can be aggressive, which is a rare condition and causes neurological deficits. Pregnancy is related to the worsening of aggressive VHs. The diagnosis and treatment of aggressive VHs remain challenging, especially for pregnant cases. PATIENT CONCERNS We report 3 cases of aggressive VH in women who developed progressive neurological deficits during pregnancy among 95 patients treated for aggressive VH in our hospital in the past 15 years. DIAGNOSES AND INTERVENTIONS All 3 patients experienced progressive deterioration of neurological function and pain at 13, 28, and 41 weeks' gestation. On radiological examination, VHs were the suspected radiological diagnoses in 2 patients; 1 patient was preoperatively misdiagnosed with a spinal metastatic tumor. All 3 patients underwent decompression surgery with intraoperative vertebroplasty and/or postoperative radiotherapy. The pathological diagnosis after surgery was all hemangiomas. OUTCOMES In all 3 patients, there were no tumor recurrences, and neurological functions remained normal at the last follow-up of 75, 38, and 15 months after the treatment, respectively. LESSONS Pregnancy might lead to the onset of aggressive VHs. The diagnosis and treatment of VHs during pregnancy remain controversial due to concern for both maternal and fetal safety. Timely surgery could preserve neurological function. Decompression surgery by laminectomy followed by adjuvant therapies require less skill and have a shorter surgery time, and can be considered more appropriate for aggressive VHs with pregnancy.
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Affiliation(s)
- Ben Wang
- Department of Orthopaedic, Peking University Third Hospital
- Peking University Health and Science Center, Beijing, China
| | - Liang Jiang
- Department of Orthopaedic, Peking University Third Hospital
| | - Feng Wei
- Department of Orthopaedic, Peking University Third Hospital
| | - Xiao Guang Liu
- Department of Orthopaedic, Peking University Third Hospital
| | - Zhong Jun Liu
- Department of Orthopaedic, Peking University Third Hospital
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Spinal Epidural Cavernous Hemangioma: A Clinical Series of 7 Patients. World Neurosurg 2018; 111:e183-e191. [DOI: 10.1016/j.wneu.2017.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 11/23/2022]
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Eichberg DG, Starke RM, Levi AD. Combined surgical and endovascular approach for treatment of aggressive vertebral haemangiomas. Br J Neurosurg 2017; 32:381-388. [DOI: 10.1080/02688697.2017.1344619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Daniel G. Eichberg
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA
| | - Robert M. Starke
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA
| | - Allan D. Levi
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA
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Fereydonyan N, Taheri M, Kazemi F. Recurrent symptomatic vertebral hemangioma during two consecutive pregnancies: Case report and review of the literature. Surg Neurol Int 2017; 8:105. [PMID: 28695052 PMCID: PMC5473073 DOI: 10.4103/sni.sni_93_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/09/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Pregnancy-related changes can exacerbate the symptoms/signs of vertebral hemangiomas. Here, we report a patient who experienced symptomatic vertebral hemangiomas resulting in cord compression during two consecutive pregnancies. CASE DESCRIPTION A 28-year-old female 34 weeks pregnant, presented with a progressive spastic paraparesis. Magnetic Resonance Imaging (MRI) demonstrated an T5 vertebral body signal change attributed to a hemangioma resulting in cord compression. Following a cesarean section, she had a trans thoracic T5 corpectomy with spinal fusion. Indeed, the histopathology was consistent with a vertebral hemangioma. She fully recovered after this first surgery. However, six years later, she again presented with a spastic paraparesis and sphincter deficit now 29 weeks pregnant. The MR demonstrated cord compression one more at the T5 level attributed to the hemangioma; following a T5 and T6 laminectomy, the left paracentral epidural vascular mass totally resected. Her child was successfully delivered 2 months later at which point she exhibited only mild residual lower limb spasticity. CONCLUSION Patients with known vertebral hemangiomas should be closely monitored during pregnancy as increased growth during these pregnancies may result in progressive spinal cord compression.
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Affiliation(s)
| | - Morteza Taheri
- Department of Neurosurgery, Rasool Akram Hospital, Tehran, Iran
| | - Farid Kazemi
- Department of Neurosurgery, Rasool Akram Hospital, Tehran, Iran
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Abstract
OBJECTIVE Vertebral hemangiomas are common tumors that are benign and generally asymptomatic. Occasionally these lesions can exhibit aggressive features such as bony expansion and erosion into the epidural space resulting in neurological symptoms. Surgery is often recommended in these cases, especially if symptoms are severe or rapidly progressive. Some surgeons perform decompression alone, others perform gross-total resection, while others perform en bloc resection. Radiation, embolization, vertebroplasty, and ethanol injection have also been used in combination with surgery. Despite the variety of available treatment options, the optimal management strategy is unclear because aggressive vertebral hemangiomas are uncommon lesions, making it difficult to perform large trials. For this reason, the authors chose instead to report their institutional experience along with a comprehensive review of the literature. METHODS A departmental database was searched for patients with a pathological diagnosis of "hemangioma" between 2008 and 2015. Medical records were reviewed to identify patients with aggressive vertebral hemangiomas, and these cases were reviewed in detail. RESULTS Five patients were identified who underwent surgery for treatment of aggressive vertebral hemangiomas during the specified time period. There were 2 lumbar and 3 thoracic lesions. One patient underwent en bloc spondylectomy, 2 patients had piecemeal gross-total resection, and the remaining 2 had subtotal tumor resection. Intraoperative vertebroplasty was used in 3 cases to augment the anterior column or to obliterate residual tumor. Adjuvant radiation was used in 1 case where there was residual tumor as well. The patient who underwent en bloc spondylectomy experienced several postoperative complications requiring additional medical care and reoperation. At an average follow-up of 31 months (range 3-65 months), no patient had any recurrence of disease and all were clinically asymptomatic, except the patient who underwent en bloc resection who continued to have back pain. CONCLUSIONS Gross-total resection or subtotal resection in combination with vertebroplasty or adjuvant radiation therapy to treat residual tumor seems sufficient in the treatment of aggressive vertebral hemangiomas. En bloc resection appears to provide a similar oncological benefit, but it carries higher morbidity to the patient.
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Affiliation(s)
| | - John H Chi
- Brigham and Women's Hospital, Harvard Medical School; and.,Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Michael W Groff
- Brigham and Women's Hospital, Harvard Medical School; and.,Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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The Radiologic Diagnosis and Treatment of Typical and Atypical Bone Hemangiomas: Current Status. Can Assoc Radiol J 2015; 67:2-11. [PMID: 26514943 DOI: 10.1016/j.carj.2014.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 07/15/2014] [Accepted: 07/23/2014] [Indexed: 12/26/2022] Open
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Guerrero-Domínguez R, González-González G, Rubio-Romero R, Federero-Martínez F, Jiménez I. [Anaesthetic management of excision of a cervical intraspinal tumor with intraoperative neurophysiologic monitoring in a pregnant woman at 29 weeks]. ACTA ACUST UNITED AC 2015; 63:297-300. [PMID: 26275733 DOI: 10.1016/j.redar.2015.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/30/2015] [Accepted: 07/08/2015] [Indexed: 11/28/2022]
Abstract
The intraoperative neurophysiological monitoring is a technique used to test and monitor nervous function. This technique has become essential in some neurosurgery interventions, since it avoids neurological injuries during surgery and reduces morbidity. The experience of intraoperative neurophysiological monitoring is limited in some clinical cases due to the low incidence of pregnant women undergoing a surgical procedure. A case is presented of a 29-weeks pregnant woman suffering from a cervical intraspinal tumour with intense pain, which required surgery. The collaboration of a multidisciplinary team composed of anaesthesiologists, neurosurgeons, neurophysiologists and obstetricians, the continuous monitoring of the foetus, the intraoperative neurophysiological monitoring, and maintaining the neurophysiological and utero-placental variables were crucial for the proper development of the surgery. According to our experience and the limited publications in the literature, no damaging effects of this technique were detected at maternal-foetal level. On the contrary, it brings important benefits during the surgery and for the final result.
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Affiliation(s)
- R Guerrero-Domínguez
- Facultativo Especialista en Anestesiología y Reanimación, Hospital de Rehabilitación y Traumatología, Hospitales Universitarios Virgen del Rocío, Sevilla, España.
| | - G González-González
- Facultativo Especialista en Anestesiología y Reanimación, Hospital de Rehabilitación y Traumatología, Hospitales Universitarios Virgen del Rocío, Sevilla, España
| | - R Rubio-Romero
- Facultativo Especialista en Anestesiología y Reanimación, Hospital de Rehabilitación y Traumatología, Hospitales Universitarios Virgen del Rocío, Sevilla, España
| | - F Federero-Martínez
- Facultativo Especialista en Anestesiología y Reanimación, Hospital de Rehabilitación y Traumatología, Hospitales Universitarios Virgen del Rocío, Sevilla, España
| | - I Jiménez
- Facultativo Especialista en Anestesiología y Reanimación, Hospital de Rehabilitación y Traumatología, Hospitales Universitarios Virgen del Rocío, Sevilla, España
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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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23
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Conservative management of maternal cervical vertebral hemangioma complicating pregnancy. Obstet Gynecol 2015; 125:735-738. [PMID: 25730240 DOI: 10.1097/aog.0000000000000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although vertebral hemangiomas are found in 10% of the population, they rarely become symptomatic. We describe management of an enlarging cervical vertebral hemangioma during pregnancy. CASE A primiparous woman at 33 weeks of gestation presented with neck pain and paresthesias. She had a known cervical hemangioma. Imaging revealed a C6-C7 hemangioma with extradural extension. Her symptoms fluctuated, and she was delivered by cesarean at 36 weeks of gestation. Improvement occurred after delivery, and radiographic regression of the hemangioma was demonstrated. CONCLUSION Hormonal and vascular changes of pregnancy may exacerbate spinal hemangiomas. Depending on the location, these may lead to profound neurologic disability and management depends on the degree of myelopathy. Surgical intervention may be necessary to avoid neurologic injury, but amelioration after delivery is possible.
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Slimani O, Jayi S, Fdili Alaoui F, Bouguern H, Chaara H, Fikri G, Alaoui Rachidi S, Sqalli Houssaini N, Himmich M, Abdelilah Melhouf M. An aggressive vertebral hemangioma in pregnancy: a case report. J Med Case Rep 2014; 8:207. [PMID: 24943121 PMCID: PMC4088364 DOI: 10.1186/1752-1947-8-207] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/21/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction Pregnancy-related compressive myelopathy secondary to vertebral hemangioma is a rare occurrence and its treatment antepartum is rare. Case presentation A 19-year-old North African woman in her 38th week of pregnancy presented with paraplegia that progressed within 2 days after a rapidly progressive weakness of her lower limbs. Magnetic resonance imaging studies showed compression of her spinal cord in front of the fourth thoracic vertebra for suspected tuberculous spondylitis. A Caesarean section was done followed by corpectomy with a bone graft because we intraoperatively discovered a vertebral hemangioma. Pathology showed an aggressive hemangioma. Conclusion At any term of pregnancy, extensive neurological involvement which is rapidly progressive due to compression should be considered for immediate decompression.
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Affiliation(s)
- Ouafae Slimani
- Department of Gynecology Obstetric II, Teaching Hospital Hassan II, Fez, Morocco.
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Abstract
OBJECTIVE This article provides an overview of the typical appearance of biomechanical and physiologic changes in pregnancy and an update on related pathophysiology. Conditions occurring during the childbearing, delivery and postpartum periods will be reported separately. CONCLUSION Pregnancy causes biomechanical and physiologic changes that may be responsible for a wide spectrum of musculoskeletal disorders in the mother.
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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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Murillo M, Zarza M, Gómez S, Chica J, Carrasquilla R, de la Vega J, Alcalá R, Suescun D. Anesthesia for emergency tracheostomy due to bleeding hemangioma of the tongue in a pregnant patient. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1016/j.rcae.2012.07.002] [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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Murillo M, Zarza M, Gómez S, Chica J, Carrasquilla R, de la Vega J, Alcalá R, Suescun D. Anestesia en embarazada para traqueostomía urgente por hemangioma sangrante en lengua. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1016/j.rca.2012.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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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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Delfyett WT, Fetzer DT. Imaging of Neurologic Conditions During Pregnancy and the Perinatal Period. Neurol Clin 2012; 30:791-822. [DOI: 10.1016/j.ncl.2012.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Anesthesia for emergency tracheostomy due to bleeding hemangioma of the tongue in a pregnant patient☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1097/01819236-201240040-00013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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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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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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Saeed G, Fakhar S, Khan I. Vertebral Tumors Mimicking Exaggerated Pregnancy Symptoms—A Need for Careful Evaluation. Taiwan J Obstet Gynecol 2010; 49:228-30. [DOI: 10.1016/s1028-4559(10)60051-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2009] [Indexed: 11/25/2022] Open
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Giant multilevel thoracic hemangioma with spinal cord compression in a patient with Klippel-Weber-Trenaunay syndrome: case report. Spine (Phila Pa 1976) 2009; 34:E498-500. [PMID: 19525830 DOI: 10.1097/brs.0b013e3181a4e4b8] [Citation(s) in RCA: 8] [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 Case report and clinical discussion. OBJECTIVE We intend to report a very rare case of a giant spinal hemangioma causing myelopathy. SUMMARY OF BACKGROUND DATA Multilevel symptomatic spinal hemangiomas causing acute neurologic symptoms are rare disorders. We found only sporadic reports in English literature. METHODS We describe a very rare case in which Klippel-Trenaunay-Weber syndrome is associated with a multisegmental vertebral hemangioma causing a rapidly progressing thoracic myelopathy. RESULTS Because of the extension of the disease, surgical intervention was not feasible, the patient was treated by radiotherapy. The patient showed a complete regression of symptoms with stable condition after 3 months. CONCLUSIONS In extensive spinal hemangiomas, radiotherapy may represent a safe treatment modality with rapid clinical improvement even in cases with spinal cord compression. This report contributes to a wide range of known vascular abnormalities in Klippel-Trenaunay-Weber syndrome and supports the need for a careful multisystemic evaluation of these patients.
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Guarnieri G, Ambrosanio G, Vassallo P, Pezzullo MG, Galasso R, Lavanga A, Izzo R, Muto M. Vertebroplasty as treatment of aggressive and symptomatic vertebral hemangiomas: up to 4 years of follow-up. Neuroradiology 2009; 51:471-6. [PMID: 19300988 DOI: 10.1007/s00234-009-0520-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 03/04/2009] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study aimed to illustrate the validity of the treatment with vertebroplasty (VP) in patients with aggressive or symptomatic vertebral hemangioma (VH) with or without epidural extension. METHODS From January 2003 to December 2007, 24 consecutive patients have been treated with VP, for a total of 36 vertebral bodies affected by VH: two cervical, ten dorsal, 24 lumbar. All the patients complained of a pain syndrome resistant to continuous medical medication; four of 24 patients also presented aggressive magnetic resonance features of the vertebral lesion and two patients showed also epidural extension. A unipedicular approach has been performed in 16 patients; a bipedicular approach has been performed in six, while for the cervical spine an anterior-lateral approach with manual dislocation of the carotid axis has always been performed. Bone biopsy was never done. All procedures have been carried out with local anesthesia, except for the treatment of the cervical hemangiomas which has always been performed under general anesthesia. Four vertebral bodies in the same session have been treated in one case. RESULTS Results have been evaluated with the visual analog scale and the Oswestry Disability Index methods. In all the patients, in the following 24-72 h, a successful outcome has been observed with a complete resolution of pain symptom. Extravertebral vascular or discal cement leakage has been observed in four patients, without any onset of clinical radicular syndrome due to epidural diffusion. Clinical and radiological follow-up until 4 years has been performed in 12 patients and it showed stability of the treatment and absence of pain. CONCLUSIONS Percutaneous treatment with VP for aggressive and symptomatic vertebral hemangiomas even with epidural extension is a valuable, mini-invasive, and quick method that allows a complete and enduring resolution of the painful vertebral symptoms without findings of fracture of a vertebral body adjacent or distant to the one treated.
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Affiliation(s)
- G Guarnieri
- Neuroradiology Service, AORNA Cardarelli, Naples, Italy.
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