Extraosseous extension of vertebral hemangioma, a rare cause of spinal cord compression

A Child with a Rare Extraosseous Extension and Pathologic Fracture from a Vertebral Hemangioma: A Case Report

CASE

We present a case of a pathologic vertebral fracture and encroachment into the spinal canal from a vertebral hemangioma in a 13-year-old boy. The original approach of embolization followed by an anterior-posterior resection and stabilization through a costotransversectomy had to be converted intraoperatively to a combined anterior and posterior approach secondary to excessive bleeding.

CONCLUSION

Because of the hypervascularity and the extensive nature of aggressive vertebral hemangiomas, surgeons attempting procedures similar to the case described herein must be prepared to adapt to the circumstances when preoperative embolization is not totally effective. Surgical technique, proper anesthesia, and patient clotting capacity are important factors to consider.

Intraoperative vertebroplasty during surgical decompression and instrumentation for aggressive vertebral hemangiomas: a retrospective study of 39 patients and review of the literature

BACKGROUND CONTEXT

Aggressive (Enneking stage 3, S3) vertebral hemangiomas (VHs) are rare, which might require surgery. However, the choice of surgery for S3 VHs remains controversial because of the rarity of these lesions.

PURPOSE

We reported our experience of treating S3 VHs, and evaluated the effectiveness and safety of intraoperative vertebroplasty during decompression surgery for S3 VHs.

STUDY DESIGN

This is a retrospective study.

PATIENT SAMPLE

Thirty-nine patients with a definitive pathologic diagnosis of aggressive VHs who underwent primary decompression surgery in our department were included in this study.

OUTCOME MEASURES

Basic data such as surgical procedure, surgical duration, estimated blood loss during surgery, and pathology were collected. The modified Frankel grade was used to evaluate neurologic function. Enneking staging was based on radiological findings.

METHODS

We retrospectively examined aggressive VHs with neurologic deficits. Surgery was indicated if the neurologic deficit was severe or developed quickly or if radiotherapy was ineffective. Decompression surgery was performed. Intraoperative vertebroplasty during posterior decompression has been used since 2009. If contrast-enhanced computed tomography (CT) revealed a residual lesion, we recommended adjuvant radiotherapy with 40-50 Gy to prevent recurrence. Patients' basic and surgical information was collected. The minimum follow-up duration was 18 months. This study was partially funded by Peking University Third Hospital, Grant no. Y71508-01.

RESULTS

Average age of the 39 patients with S3 VHs who underwent primary decompression surgery was 46.2 (range, 10-69) years. All patients had neurologic deficits caused by aggressive VHs. Aggressive VH lesions were located in the cervical, thoracic, and lumbar spine in 2, 32, and 5 patients, respectively. The decompression-alone group had 17 patients, and the decompression plus intraoperative vertebroplasty group had 22. There were no statistically significant intergroup differences in preoperative information (p>.05). The average estimated blood losses were 1,764.7 mL (range, 500-4,000 mL) and 1,068.2 mL (range, 300-3,000 mL) in the decompression-alone group and decompression plus vertebroplasty group, respectively (p=.017). One patient who underwent primary decompression alone without adjuvant radiotherapy experienced recurrence after the first decompression. The average follow-up was 50.2 (range, 18-134) months, and no cases of recurrence were observed at the last follow-up.

CONCLUSIONS

Our results suggest that posterior decompression effectively provides symptom relief in patients with aggressive (S3) VHs with severe spinal cord compression. Intraoperative vertebroplasty is a safe and effective method for minimizing blood loss during surgery, whereas adjuvant radiotherapy or vertebroplasty helps in minimizing recurrence after decompression.

Blood Loss in Surgery for Aggressive Vertebral Haemangioma with and without Embolisation

Despite their benign nature some symptomatic aggressive vertebral haemangiomas (AVH) require surgery to decompress spinal cord and/or stabilise pathological fractures. Preoperative embolisation may reduce the considerable blood loss during surgical decompression. This systematic review investigated whether preoperative embolisation reduced surgical blood loss during treatment of symptomatic AVH. PubMed Medline, Web of Science, and Ovid Medline were searched for case reports and clinical studies on surgical AVH treatment. Included were cases from all publications on surgical treatment of AVH where the amount of surgical blood loss and the use of preoperative embolisation were documented. 51 cases with surgically treated AVH were retrieved from the included studies. Blood loss in the embolised treatment group (980±683 mL) was lower than the non-embolised control group (1,629±946 mL). This systematic review found that embolisation prior to AVH resection reduced surgical blood loss (level of evidence, very low) and can be recommended (strong recommendation).

Total en bloc spondylectomy for locally aggressive vertebral hemangioma causing neurological deficits

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.

Multilevel thoracic hemangioma with spinal cord compression in a pediatric patient: case report and review of the literature

PURPOSE

Vertebral hemangiomas are common benign vascular tumors of the spine. It is very rare for these lesions to symptomatically compress neural elements. If spinal cord compression does occur, it usually involves only a single level. Multilevel vertebral hemangiomas causing symptomatic spinal cord compression have never been reported in the pediatric population to the best of our knowledge.

METHODS

We report the case of a 15-year-old boy presenting with progressive paraparesis due to thoracic spinal cord compression from a multilevel thoracic hemangioma (T5-T10) with epidural extension.

RESULTS

Because of his progressive neurological deficit, he was initially treated with urgent multilevel decompressive laminectomies from T4 to T11. This was to be followed by radiotherapy for residual tumor, but the patient was unfortunately lost to follow-up. He re-presented 3 years later with recurrent paraparesis and progressive disease. This was treated with urgent radiotherapy with good response. As of 6 months follow-up, he has made an excellent neurological recovery.

CONCLUSIONS

In this report, we present the first case of a child with multilevel vertebral hemangiomas causing symptomatic spinal cord compression and review the literature to detail the pathophysiology, management, and treatment of other cases of spinal cord compression by vertebral hemangiomas.

Noncontiguous lumbar vertebral hemangiomas treated by posterior decompression, intraoperative kyphoplasty, and segmental fixation

Vertebral hemangiomas are benign lesions and are often asymptomatic. Most vertebral hemangiomas that cause cord compression and neurological symptoms are located in the thoracic spine and involve a single vertebra. The authors report the rare case of lumbar hemangiomas in a 60-year-old woman presenting with severe back pain and rapidly progressive neurological signs attributable to 2 noncontiguous lesions. After embolization of the feeding arteries, no improvement was noted. Thus, the authors performed open surgery using a combination of posterior decompression, intraoperative kyphoplasty, and segmental fixation. The patient experienced relief from back and leg pain immediately after surgery. At 3 months postoperatively, her symptoms and neurological deficits had improved completely. To the authors' knowledge, this is the first description of 2 noncontiguous extensive lumbar hemangiomas presenting with neurological symptoms managed by such combined treatment. The combined management seems to be an effective method for treating symptomatic vertebral hemangiomas.

Lumbar hemangioma masking a plasma cell tumor--case report and review of the literature

BACKGROUND CONTEXT

Vertebral hemangiomata are ubiquitous bone tumors. Often multiple, they are generally benign in nature and slow growing. They typically have a predictable radiographic appearance. Occasionally, hemangiomata may behave in a more aggressive manner, causing pathologic fracture or even symptoms/signs of nerve compression. In such cases, one must be careful not to assume that an atypical hemangioma is responsible. Coexisting, more malignant processes may be present and sometimes may be radiographically undetectable in the setting of acute fracture. This was the case in our patient.

STUDY DESIGN

Case report/university spine surgery center.

METHODS

The patient underwent a corpectomy of her affected vertebra with conversion to a total spondylectomy when intraoperative frozen section was consistent with plasma cell neoplasm. A reconstruction with vertebral body replacement and fusion through anterior and posterior approaches was completed. Subsequently, the literature was reviewed for other cases of atypical hemangiomata to investigate the incidence of coexistent lesions.

RESULTS

This patient presented with pain secondary to an unstable pathologic vertebral body fracture. Surgery to stabilize her spine was elected. Intraoperative recognition of abnormal-appearing tissue led to the diagnosis of a plasma cell neoplasm that was not seen on imaging. Coexistent in the same vertebra was hemangiomatous tissue that was visible on preoperative imaging.

CONCLUSIONS

There are rare reports of aggressively behaving hemangiomata that mainly have occurred in the thoracic spine. There have been no reports of the coexistence of a hemangioma and a plasma cell tumor in the same vertebral level in the setting of acute compression fracture.

The role of embolization for hemangiomas

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.

Clinical and imaging findings in patients with aggressive spinal hemangioma requiring surgical treatment

Vertebral hemangiomas (VHs) are frequently asymptomatic lesions found incidentally during investigations for other spinal problems. Symptomatic VHs are less common, and there are few reports of compressive VHs in the literature. VHs with aggressive behavior present with low signal intensity on T1-weighted and high signal intensity on T2-weighted MRI. We present a case series of four patients with compressive VH, all of whom were neurologically compromised. Each of the four patients underwent preoperative arterial embolization followed by surgical treatment of their VHs. All patients recovered normal motor function after surgery. At follow-up (average 53 months), one patient had a recurrent tumor requiring reoperation and radiotherapy. Although it is rare, aggressive VH can be a devastating condition. Total surgical resection or subtotal resection with radiotherapy may be warranted.

Surgical management of aggressive vertebral hemangiomas causing spinal cord compression: long-term clinical follow-up of five cases

BACKGROUND

Aggressive vertebral hemangiomas causing spinal compression are rare, and there is controversy with regard to treatment. The purpose of this study was to evaluate the clinical results of patients with aggressive vertebral hemangiomas at a mean follow-up of more than 10 years after total excision and discuss the treatment options for the tumors.

METHODS

We performed a retrospective review of patients with aggressive vertebral hemangiomas who were treated with total excision. The surgeries were carried out on five patients (average age 47 years). In all five patients, the tumor was in the thoracic spine and was causing myelopathy with extraosseous extension. There were three tumors of type 5 and two of type 6 according to Tomita's surgical classification of spinal tumors. The tumors were assessed using magnetic resonance imaging (MRI), and the clinical results were evaluated.

RESULTS

All of the tumors showed low-intensity or low-isointensity signal on T1-weighted MRI. All five patients had a combination of preoperative transarterial embolization and total excision including tumor margin. Total en bloc excisions were performed in two patients. En bloc and piecemeal combined total excisions were performed in two patients. Piecemeal total excision was performed in one patient. Intraoperative blood loss ranged from 1580 to 3400 ml (mean 2424 ml). There were no perioperative complications. According to the Japanese Orthopaedic Association score, the myelopathy improved after the surgery from 5.3 +/- 2.9 to 9.8 +/- 1.7 (total of 11 points). None of the patients have had a recurrence at a mean followup of 135.2 months (range 92-163 months).

CONCLUSIONS

We performed a combination of preoperative transarterial embolization and total excision for aggressive vertebral hemangiomas with extraosseous extension that were causing spinal cord compression in all five cases. The results in the long-term follow-up have proved satisfactory.

Radiotherapy for symptomatic vertebral hemangiomas: results of a multicenter study and literature review

PURPOSE

The current study analyzes the potential role of radiotherapy (RT) in symptomatic vertebral hemangioma (SVH).

METHODS AND MATERIALS

Seven cooperating German institutions collected clinical information, treatment plans, and outcome data for all patients with SVH referred for local RT.

RESULTS

From 1969 to 2008, a total of 84 patients with 96 symptomatic lesions were irradiated for SVH. The primary indication for radiotherapy was pain (97.6%), and 28.6% of patients had additional neurological symptoms. RT was performed at a median total dose of 34 Gy, with a median single dose of 2.0 Gy. After receiving a median follow-up of 68 months, the overall patient response rate was 90.5%. Complete symptom remission occurred in 61.9% of patients, 28.6% of patients had partial pain relief, and 9.5% of patients had no pain relief. In 26.2% of patients, radiological signs of reossification were observed in long-term follow-up but not significantly correlated with pain relief. Most importantly, total doses of >/=34 Gy resulted in significantly greater symptomatic relief and control rate than total doses of <34 Gy.

CONCLUSIONS

This study consists of the largest database of cases reported so far using RT for SVH. RT is easy, safe, and effective for pain relief treatment for SVH. Total doses of at least 34 Gy give the best symptomatic response.

Lumbosacral osseous tumors in children

A wide variety of benign and malignant neoplasms in children involve the lumbosacral region. When a solitary lesion of the lower spine occurs, tumors or tumor-like lesions represent an important group of entities for diagnostic consideration. Diagnostic investigation should begin with a patient history, physical examination, laboratory testing, and radiography. Roentgenograms, which demonstrate bone deviations, should be used as an initial examination. The results should direct further imaging studies, such as computed tomography (CT), magnetic resonance imaging (MRI), and bone scintigraphy. CT should be the chosen modality for delineating tumoral osteoid matrix formation. MRI shows soft-tissue masses and medullary infiltration better than any other radiological modality. A multimodal radiological approach is helpful in the overall evaluation and differential diagnosis of vertebral lesions in children. Although imaging features, especially of benign lesions, may yield a high percentage of accurate diagnoses, in cases with radiological findings highly suggestive of malignancy, a specific diagnosis cannot always be made, and histopathological findings are essential to achieve the diagnosis that will guide the therapy.

Association of multiple vertebral hemangiomas and severe paraparesis in a patient with a PTEN hamartoma tumor syndrome. Case report

The PTEN hamartoma tumor syndrome, manifestations of which include Cowden disease and Bannayan-Riley-Ruvalcaba syndrome, is caused by various mutations of the PTEN gene located at 10q23. Its major criteria are macrocephaly and a propensity to develop breast and thyroid cancers as well as endometrial carcinoma. Minor diagnostic criteria include hamartomatous intestinal polyps, lipomas, fibrocystic disease of the breasts, and fibromas. Mutations of PTEN can also be found in patients with Lhermitte-Duclos disease (dysplastic gangliocytoma of the cerebellum). The authors report the case of a 17-year-old girl who had a severe cyanotic cardiac malformation for which surgery was not advised and a heterozygous missense mutation (c.406T>C) in exon 5 of PTEN resulting in the substitution of cysteine for arginine (p.Cysl36Arg) in the protein, which was also found in her mother and sister. The patient presented in the pediatric emergency department with severe spastic paraparesis. A magnetic resonance imaging study of the spine showed vertebral hemangiomas at multiple levels, but stenosis and compression were maximal at level T5-6. An emergency T5-6 laminectomy was performed. The decompression was extremely hemorrhagic because the rapid onset of paraparesis necessitated prompt treatment, and there was no time to perform preoperative embolization. The patient's postoperative course was uneventful with gradual recovery. This represents the first report of an association of a PTEN mutation and multiple vertebral angiomas. The authors did not treat the remaining angiomas because surgical treatment was contraindicated without previous embolization, which in itself would present considerable risk in this patient with congenital cyanotic heart disease.

Total spondylectomy of a symptomatic hemangioma of the lumbar spine

A vertebral hemangioma with dural compression and neurological deficit is rare. We report a symptomatic lumbar vertebral hemangioma which was successfully managed with total spondylectomy. The patient was a 31-year-old man whose chief complaint was low back pain. He had a slight sensory disturbance in the right thigh. Plain radiography and magnetic resonance imaging (MRI) revealed a tumor in the second lumbar vertebra, which extended into the spinal canal, compressing the dura. A percutaneous needle biopsy did not provide a pathological diagnosis. Before surgery, the arteries feeding the tumor were embolized using coils. We performed a total spondylectomy of the second lumbar vertebra with anterior reconstruction with a glass ceramic spacer and posterior instrumentation. The intraoperative pathological examination revealed a hemangioma of the lumbar spine. At the 4-year follow-up examination, the patient is completely asymptomatic without evidence of tumor recurrence.

Lumbar vertebral hemangioma presenting with the acute onset of neurological symptoms. Case report

Vertebral hemangiomas are common entities that rarely present with neurological deficits. The authors report the unusual case of a large L-3 vertebral hemangioma with epidural extension in a 27-year-old woman who presented with hip flexor and quadriceps weakness, foot drop, and leg pain. The characteristics of the mass on magnetic resonance imaging suggested an aggressive, hypervascular lesion. The patient underwent embolization of the lesion followed by direct intralesional injection of ethanol. Significant resolution of clinical symptoms was observed immediately after the procedure and at her follow-up visits. Follow-up imaging studies obtained 9 months after the procedure also documented a considerable reduction in the size of the hemangioma with minimal loss of vertebral height and a mild kyphosis at the affected level. On repeated imaging studies obtained 21 months postoperatively, the size of the hemangioma and the degree of vertebral body compression were stable. As demonstrated in this case, patients with vertebral hemangiomas can present with acute nerve root compression and signs and symptoms similar to those of disc herniation. Vertebral hemangiomas can be treated effectively with interventional techniques such as embolization and ethanol injection.

Symptomatic vertebral hemangioma related to pregnancy

In this paper, we report a case of vertebral hemangioma during pregnancy in a 21-year-old woman presenting with paraparesis of rapid onset. An emergency MRI scan of the dorsal spine showed a lesion of the ninth thoracic vertebra with extradural extension and marked spinal cord compression. A cesarean section was done, and this was followed by emergent laminectomy. Her symptoms and neurologic deficits quickly improved. The etiopathogenesis, clinical, radiological features, and treatment modalities are discussed in the light of the literature.

[Imaging of extradural spinal lesions]

There is a wide variety of spinal extradural tumors. In addition to real neoplasms, degenerative diseases, congenital abnormalities and inflammatory disorders can be causes of extradural masses. Due to the bony boundary of the spinal canal, both benign as well as malignant masses can cause progressive neurological deficits including paraplegia. Most of the spinal tumors are benign (hemangioma of the vertebral body, degenerative diseases). In younger patients congenital abnormalities and primary tumors of the spine have to be considered, whereas in adults the list of differential diagnoses should include secondary malignancies such as metastases and lymphomas as well as metabolic disorders such as osteoporotic vertebral compression fracture and Paget's disease. Cross-sectional imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) of the spine often help to make a specific diagnosis of extradural spinal lesions and represent important tools for tumor staging and preoperative evaluation.

Epidural extension of a lumbar vertebral haemangioma

Vertebral haemangiomas are relatively common, but those extending into the epidural space are rare. A 59-year-old man with severe lower back and right leg pain that did not resolve with conservative treatment was seen in an outpatient clinic. Magnetic resonance imaging of the lumbar spine identified an L3 vertebral corpus lesion with epidural extension. The diagnosis was unclear, so the patient underwent surgery. The pathologic diagnosis was capillary haemangioma, so angiography-guided embolization was performed postoperatively. Vertebral haemangioma must be considered when there is evidence of a vertebral corpus lesion with epidural extension on magnetic resonance imaging.

Expandable vertebral body replacement in patients with thoracolumbar spine tumors

INTRODUCTION

The objectives of surgical interventions for tumoral lesions of the spine include the establishment and improvement of tumor-related symptoms. Anterior tumor resection followed by reconstruction indicated if surgical treatment allowed a marginal removal of the tumor or could extend the individual survival rate in combination with adjuvant therapy options. Sufficient re-stabilization depends on adequate anterior column reconstruction. The purpose of this retrospective study was to present our experiences and results after anterior tumor resection followed by reconstruction with the expandable vertebral body replacement device (VBR, Ulrich, Germany) based on clinical application over 4 degrees years.

PATIENTS AND METHODS

We carried out an anterior tumor resection followed by reconstruction using an anterior extendable device in 32 patients with different spine tumors between 1996 and 2000. A retrospective evaluation was executed considering the patients medical records and radiological findings. Additionally, a clinical and radiological investigation of still living postoperative patients was carried out.

RESULTS

The mean surgical time of all evaluated patients was 317.2 min. The average blood loss was 1,272.5 ml. According to the Tokuhashi score, patients with a postoperative survival time of at least 12 months demonstrated a score value > or = 9 points. According to our evaluated patients group metastatic lesions of the spine represented the largest group (78.1%). The average survival rate of this group amounted to 18.4 months postoperatively. Considering primary tumors the average survival rate at the time of last re-examination amounted to 34.8 months postoperatively. Preoperative neurological pathologies were present in 12 patients (Frankel stage C-D). During the postoperative monitoring period 58.3% of the patients demonstrated an improvement in initial neurological findings. There were no intraoperative complications or perioperative deaths. Implant dislocations were not observed.

CONCLUSION

On account of the underlying, the anterior tumor resection with supplementary instrumentation represented a sufficient procedure in spinal tumor surgery. Adjuvant therapy can influence the postoperative survival period positively in addition to the surgical procedure. Following anterior tumor resection, extendable vertebral body replacements like the VBR device provide immediate spine stability by excellent defect adaptation. With regard to their intraoperative flexibility, expandable cages are more advantageous in contrast to non-expandable implants or bone grafts.

Multilevel vertebral hemangiomas: two episodes of spinal cord compression at separate levels 10 years apart

This case report presents a 66-year-old woman with multiple vertebral hemangiomas causing spinal cord compression at different levels with a long symptom-free interval between episodes of compression. She presented with back pain and progressive weakness and numbness in her lower limbs for 3 months. Ten years earlier, she had had a symptomatic T4 vertebral hemangioma operated successfully, and had made a full recovery. Magnetic resonance imaging (MRI) of the thoracic and lumbar spine revealed multiple thoracic and lumbar vertebral hemangiomas. Extraosseous extension of a hemangioma at T9 was causing spinal cord compression. Selective embolization was performed preoperatively, and cord decompression was achieved via anterior T9 corpectomy. The patient's neurological status improved rapidly after surgery. After a course of radiotherapy, she was neurologically intact and could walk independently. One year later, MRI showed complete resolution of the cord edema at T9, and showed regression of the high signal intensity that had been observed at unoperated levels. These findings indicated diminished vascularity and reduced aggression of the tumor.

Acute spinal cord compression caused by vertebral hemangioma

BACKGROUND CONTEXT

The reported incidence of vertebral hemangioma within the spinal column is common. Most often these benign vascular tumors are incidental radiographic findings and do not cause neurological sequelae. Rarely, vertebral hemangiomas will cause compressive neurological symptoms, such as radiculopathy, myelopathy and paralysis. In these cases the clinical presentation is usually the subacute or delayed onset of progressive neurological symptoms. This report demonstrates a symptomatic vertebral hemangioma presenting with rapid onset neurologic sequelae.

PURPOSE

To discuss diagnostic and management issues presented by symptomatic vertebral hemangioma.

STUDY DESIGN

Case report and review of literature.

PATIENT SAMPLE

Sixty-one-year-old white woman with low back pain and rapidly progressive myelopathic symptoms.

METHODS

A case of vertebral hemangioma with neurological sequelae is presented followed by a discussion of the literature concerning diagnostic and therapeutic options in the management of this pathologic entity.

RESULTS

The results of our review reveal that the incidence of vertebral hemangioma causing compressive neurological symptoms is rare despite the overall prevalence of vertebral hemangioma. Vertebral hemangioma may present with rapid onset myelopathic symptoms and may mimic those symptoms caused by a malignancy. Radiographic imaging modalities are extremely useful and display characteristic findings in the diagnostic evaluation of these tumors. Angiographic embolization of feeding vessels has been effective in minimizing operative blood loss, and surgical decompression and stabilization is frequently indicated. Postsurgical radiotherapy has also been demonstrated to serve as a limited adjunct to surgery by reducing tumor recurrence in the event of less than complete tumor resection.

CONCLUSIONS

Because of the rapid presentation of myelopathic symptoms in this case, preoperative angiographic embolization was not performed, and the patient underwent emergent decompressive surgery. In this case emergent operative decompression and stabilization was effective in reversing the patient's myelopathic symptoms, while maintaining long-term stability of the spinal column. Postoperative radiation was not administered because of the extent of tumor resection. Surgical intervention has produced long-term cure of this patient's myelopathy and T10 vertebral hemangioma.