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Timilsina K, Shrestha S, Bhatta OP, Paudel S, Lakhey RB, Pokharel RK. Atypical Aggressive Hemangioma of Thoracic Vertebrae Associated With Thoracic Myelopathy-A Case Report and Review of the Literature. Case Rep Orthop 2024; 2024:2307950. [PMID: 39165484 PMCID: PMC11335424 DOI: 10.1155/2024/2307950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 07/05/2024] [Accepted: 08/02/2024] [Indexed: 08/22/2024] Open
Abstract
Aggressive thoracic hemangiomas are rare, benign tumors that extend into the spinal canal and cause neurological symptoms. Delayed diagnosis and treatment, due to a paucity of literature on optimal treatment strategies, can increase morbidity. This case report describes a 19-year-old male patient with aggressive thoracic hemangioma who presented with upper back pain and progressive weakness of the lower extremities. The patient underwent preoperative embolization and sclerotherapy, followed by decompression, posterior instrumentation, and stabilization. The final diagnosis was confirmed by biopsy, and there was a significant improvement in neurology after the surgical intervention. The diagnosis of rare lesions, such as aggressive hemangiomas, requires a high level of clinical suspicion and the assistance of imaging modalities in patients with features of compressive myelopathy. A combination of endovascular and surgical approaches can lead to optimal outcomes.
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Affiliation(s)
| | - Sandesh Shrestha
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | - Sushil Paudel
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Rajesh Bahadur Lakhey
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Rohit Kumar Pokharel
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Teaching Hospital, Kathmandu, Nepal
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Ren J, Cui Z, Jiang C, Wang L, Guan Y, Ren Y, Zhang S, Tu T, Yu J, Li Y, Duan W, Guan J, Wang K, Zhang H, Xing D, Kahn ML, Zhang H, Hong T. GNA14 and GNAQ somatic mutations cause spinal and intracranial extra-axial cavernous hemangiomas. Am J Hum Genet 2024; 111:1370-1382. [PMID: 38917801 PMCID: PMC11267519 DOI: 10.1016/j.ajhg.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
Extra-axial cavernous hemangiomas (ECHs) are complex vascular lesions mainly found in the spine and cavernous sinus. Their removal poses significant risk due to their vascularity and diffuse nature, and their genetic underpinnings remain incompletely understood. Our approach involved genetic analyses on 31 tissue samples of ECHs employing whole-exome sequencing and targeted deep sequencing. We explored downstream signaling pathways, gene expression changes, and resultant phenotypic shifts induced by these mutations, both in vitro and in vivo. In our cohort, 77.4% of samples had somatic missense variants in GNA14, GNAQ, or GJA4. Transcriptomic analysis highlighted significant pathway upregulation, with the GNAQ c.626A>G (p.Gln209Arg) mutation elevating PI3K-AKT-mTOR and angiogenesis-related pathways, while GNA14 c.614A>T (p.Gln205Leu) mutation led to MAPK and angiogenesis-related pathway upregulation. Using a mouse xenograft model, we observed enlarged vessels from these mutations. Additionally, we initiated rapamycin treatment in a 14-year-old individual harboring the GNAQ c.626A>G (p.Gln209Arg) variant, resulting in gradual regression of cutaneous cavernous hemangiomas and improved motor strength, with minimal side effects. Understanding these mutations and their pathways provides a foundation for developing therapies for ECHs resistant to current therapies. Indeed, the administration of rapamycin in an individual within this study highlights the promise of targeted treatments in treating these complex lesions.
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Affiliation(s)
- Jian Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, National Center for Neurological Disorders, Beijing, China
| | - Ziwei Cui
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, National Center for Neurological Disorders, Beijing, China
| | - Chendan Jiang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, National Center for Neurological Disorders, Beijing, China
| | - Leiming Wang
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yunqian Guan
- Cell Therapy Center, Beijing Institute of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, and Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China
| | - Yeqing Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, National Center for Neurological Disorders, Beijing, China
| | - Shikun Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, National Center for Neurological Disorders, Beijing, China
| | - Tianqi Tu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, National Center for Neurological Disorders, Beijing, China
| | - Jiaxing Yu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, National Center for Neurological Disorders, Beijing, China
| | - Ye Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, National Center for Neurological Disorders, Beijing, China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, National Center for Neurological Disorders, Beijing, China
| | - Jian Guan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, National Center for Neurological Disorders, Beijing, China
| | - Kai Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, National Center for Neurological Disorders, Beijing, China
| | - Hongdian Zhang
- Department of Neurosurgery, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Dong Xing
- Biomedical Pioneering Innovation Center (BIOPIC), School of Life Sciences, Peking University, Beijing, China; Beijing Advanced Innovation Center for Genomics (ICG), Peking University, Beijing, China
| | - Mark L Kahn
- Department of Medicine and Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, National Center for Neurological Disorders, Beijing, China.
| | - Tao Hong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, National Center for Neurological Disorders, Beijing, China; Department of Neurosurgery, Xiongan Xuanwu Hospital, Xiong'an New Area, China.
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Potparić I, Brumat P, Bošnjak K, Vodičar M. Revision total en bloc spondylectomy for a recurrent aggressive vertebral haemangioma of the thoracic spine causing progressive thoracic myelopathy with segmental kyphosis. J Surg Case Rep 2024; 2024:rjae461. [PMID: 39015117 PMCID: PMC11249918 DOI: 10.1093/jscr/rjae461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/27/2024] [Accepted: 07/09/2024] [Indexed: 07/18/2024] Open
Abstract
Vertebral haemangiomas are common amongst primary benign tumours of the spine, usually asymptomatic and discovered incidentally, whereby symptomatic cases are rare. Aggressive vertebral haemangiomas, occurring even less frequently, are characterized by their expansion, resulting in pain and neural compression symptoms. Depending on presentation and severity, several treatment options exist, and when causing progressive neurological deficit, surgical decompression and resection is warranted. Despite local recurrence being rare, regular follow-ups to detect recurrence are advised. In case of recurrent aggressive vertebral haemangiomas, however, subsequent treatment strategy usually depends on a case-by-case consideration, whereby reports in the literature are lacking. We describe a case of a recurrent aggressive vertebral haemangiomas of the thoracic spine in a 20-year-old male causing progressive thoracic myelopathy with segmental kyphosis, treated with a revision total en bloc spondylectomy and a multilevel fixation with vertebral column reconstruction using radiolucent instrumentation.
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Affiliation(s)
- Igor Potparić
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
- Department of Orthopaedic Surgery, Ljubljana University Medical Centre, Zaloška cesta 9, 1000 Ljubljana, Slovenia
| | - Peter Brumat
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
- Department of Orthopaedic Surgery, Ljubljana University Medical Centre, Zaloška cesta 9, 1000 Ljubljana, Slovenia
- Department of Spine Surgery, Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280 Ankaran, Slovenia
| | - Klemen Bošnjak
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
- Department of Orthopaedic Surgery, Ljubljana University Medical Centre, Zaloška cesta 9, 1000 Ljubljana, Slovenia
| | - Miha Vodičar
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
- Department of Orthopaedic Surgery, Ljubljana University Medical Centre, Zaloška cesta 9, 1000 Ljubljana, Slovenia
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Kesavapisharady K, Divakar G, George T, E R J, Venkat Hariharan E. Compressive vertebral hemangiomas with neurological deficits: diagnosis, surgical strategies and long term outcome. Br J Neurosurg 2024; 38:735-745. [PMID: 34435527 DOI: 10.1080/02688697.2021.1967878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/29/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Compressive vertebral hemangiomas with neurological deficits (CVHND) form a rare, unique subset of lesions comprising of differing clinico-imaging findings, pathologic behavior and treatment, when compared to the commoner and usually incidental intra-osseus vertebral hemangiomas (VH). Though various surgical strategies and a broad array of adjuncts have evolved and changed over the years, there is paucity of comprehensive data from sizeable series of such patients treated surgically with long term follow up. The purpose of this study is to device an optimum management strategy in CVHND based on our surgical experience. MATERIALS AND METHODS The data from electronic medical records of 26 consecutive patients operated in our department from 2009 to 2019 were retrospectively analyzed. RESULTS There were 11 males and 15 females with a mean age of 34.7 years. Neurological examination revealed paraparesis or paraplegia with myelopathy in all patients with Frankel score of B, C and D in 1 (3.9%), 11 (42.3%) and 14 (53.8%) patients respectively. Sixteen patients (61%) underwent laminectomy and gross total excision of extradural soft tissue component, 7 (27%) laminectomy with posterolateral fusion, three (12%) underwent additional anterior interbody support. The mean follow up was 72.4 months and at last follow-up 24 patients (92%) were Frankel E. Symptomatic recurrence was seen in two patients operated early in the series, they underwent re-surgery, gross total excision with posterolateral fusion, remaining neurologically intact at last follow up. CONCLUSIONS Pre-operative embolization, surgical excision of extradural component and intra-operative vertebroplasty form the mainstay of treatment for CVHND. Instrumented posterolateral fusion with optional anterior interbody support accomplished through the same approach is required only in a minority of cases. The long-term outcome following timely and appropriate treatment is excellent. Anterior or anterolateral approaches for intervertebral support and radical procedures like total en-bloc spondylectomy (TES) are not usually required.
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Affiliation(s)
- Krishnakumar Kesavapisharady
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Ganesh Divakar
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Tobin George
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Jayadevan E R
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Easwer Venkat Hariharan
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
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De Los Rios D, Germano C, Corvino S, Bocchetti A, Corazzelli G. Percutaneous Vertebroplasty as the Treatment of Choice for Multiple Adjacent Lumbar Atypical Haemangiomas: A Case Report. Cureus 2024; 16:e58171. [PMID: 38741874 PMCID: PMC11089486 DOI: 10.7759/cureus.58171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
Atypical vertebral haemangiomas (VHs) are uncommon lesions that cause lumbar pain and motor symptoms. Current management mainly relies on radiotherapy, surgical spine decompression, or percutaneous techniques. We describe a unique case of a patient with two adjacent lumbar VHs and an underlying lumbar fracture which was treated only by percutaneous vertebroplasty (PV). The non-invasive technique relieved the patient's pain and did not affect column stability. PV may be considered an amenable pain-relieving treatment for adjacent atypical VHs in selected patients.
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Affiliation(s)
- Davide De Los Rios
- Department of Medicine, Università degli Studi di Napoli "Federico II", Naples, ITA
| | - Cristiana Germano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, ITA
| | - Sergio Corvino
- Neurosurgery Division, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Napoli, ITA
| | | | - Giuseppe Corazzelli
- Neurosurgery Division, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, ITA
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Tedesco G, Noli LE, Griffoni C, Ghermandi R, Facchini G, Peta G, Papalexis N, Asunis E, Pasini S, Gasbarrini A. Electrochemotherapy in Aggressive Hemangioma of the Spine: A Case Series and Narrative Literature Review. J Clin Med 2024; 13:1239. [PMID: 38592093 PMCID: PMC10932223 DOI: 10.3390/jcm13051239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: this case series and literature review aims to evaluate the efficacy and safety of electrochemotherapy in the management of aggressive spinal hemangiomas, presenting two distinct cases. (2) Methods: we present two cases of spinal aggressive hemangioma which were refractory to conventional treatments and underwent electrochemotherapy. Case 1 involves a 50-year-old female who presented with an aggressive spinal hemangioma of L1, who previously underwent various treatments including surgery, radio-chemotherapy, and arterial embolization. Case 2 describes a 16-year-old female with a T12 vertebral hemangioma, previously treated with surgery and stabilization, who faced limitations in treatment options due to her young age and the location of the hemangioma. (3) Results: in Case 1, electrochemotherapy with bleomycin was administered following the failure of previous treatments and resulted in the reduction of the lesion size and improvement in clinical symptoms. In Case 2, electrochemotherapy was chosen due to the risks associated with other treatments and was completed without any adverse events. Both cases demonstrated the potential of electrochemotherapy as a viable treatment option for spinal hemangiomas, especially in complex or recurrent cases. (4) Conclusions: electrochemotherapy with bleomycin is a promising treatment for aggressive spinal hemangiomas when conventional therapies are not feasible or have failed. Further research is needed to establish definitive protocols and long-term outcomes of electrochemotherapy in spinal hemangioma management.
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Affiliation(s)
- Giuseppe Tedesco
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Luigi Emanuele Noli
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche Bologna, Bellaria Hospital, 40139 Bologna, Italy;
| | - Cristiana Griffoni
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Riccardo Ghermandi
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.F.); (G.P.); (N.P.)
| | - Giuliano Peta
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.F.); (G.P.); (N.P.)
| | - Nicolas Papalexis
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.F.); (G.P.); (N.P.)
| | - Emanuela Asunis
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Stefano Pasini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Alessandro Gasbarrini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
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Sop FYL, Benato A, Izoudine BK, Khouri K, Marangon A, Fraschetti F, Lonjon N, Ferraresi S. Spinal lymphangiomas: Case-based review of a chameleonic disease entity. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:4-14. [PMID: 38644908 PMCID: PMC11029117 DOI: 10.4103/jcvjs.jcvjs_125_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/31/2023] [Indexed: 04/23/2024] Open
Abstract
Purpose Lymphangiomas are benign hamartomas in the spectrum of lymphatic malformations, exhibiting multifaceted clinical features. Spinal involvement is exceedingly rare, with only 35 cases reported to date. Both due to their rarity and chameleonic radiologic features, spinal lymphangiomas (SLs) are usually misdiagnosed; postoperatively, surgeons are thus confronted with an unexpected histopathological diagnosis with sparse pertinent literature and no treatment guidelines available. Methods Here, we report the case of a 67-year-old female who underwent surgery for a T6-T7 epidural SL with transforaminal extension, manifesting with spastic paraparesis. Then, we present the results of the first systematic review of the literature on this subject, delineating the clinical and imaging features and the therapeutic implications of this rare disease entity. Results Our patient was treated with T6-T7 hemilaminectomy and resection of the epidural mass, with complete recovery of her neurological picture. No recurrence was evident at 18 months. In the literature, 35 cases of SL were reported that can be classified as vertebral SL (n = 18), epidural SL (n = 10), intradural SL (n = 3), or intrathoracic lymphangiomas with secondary spinal involvement (n = 4). Specific treatment strategies (both surgical and nonsurgical) were adopted in relation to each of these categories. Conclusion Gathering knowledge about SL is fundamental to promote both correct preoperative identification and appropriate perioperative management of this rare disease entity. By reviewing the literature and discussing an exemplary case, we delineate a framework that can guide surgeons facing such an unfamiliar diagnosis.
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Affiliation(s)
- François Yves Legninda Sop
- Department of Neurosurgery, CHU Montpellier, Montpellier, France
- Department of Neurosurgery, Ospedale Santa Maria Della Misericordia, Rovigo, Italy
| | - Alberto Benato
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Kifah Khouri
- Department of Neurosurgery, CHU Montpellier, Montpellier, France
| | - Anna Marangon
- Department of Anesthesiology and Critical Care Medicine, Ospedale Santa Maria Della Misericordia, Rovigo, Italy
| | - Flavia Fraschetti
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicolas Lonjon
- Department of Neurosurgery, CHU Montpellier, Montpellier, France
| | - Stefano Ferraresi
- Department of Neurosurgery, Ospedale Santa Maria Della Misericordia, Rovigo, Italy
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Swaminathan G, Jonathan GE, Mani SA, Keshava SN, Moses V, Prabhu K. Surgical strategies in the management of aggressive spinal haemangiomas: Retrospective case series with literature review and a practical treatment algorithm. BRAIN & SPINE 2023; 4:102736. [PMID: 38510623 PMCID: PMC10951693 DOI: 10.1016/j.bas.2023.102736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/21/2023] [Accepted: 12/11/2023] [Indexed: 03/22/2024]
Abstract
Purpose We studied the clinico-radiological features and treatment outcomes of patients with aggressive spinal haemangiomas. Methods We undertook a retrospective review of 24 patients with aggressive spinal haemangiomas managed at our centre from 2004 to 2016. The cohort was divided into two groups. Group1 included patients managed from 2004 to 2009 while Group 2 was those treated between 2010 and 2016. Clinicoradiological features and treatment outcomes were studied. Results Back pain (24/24) and myelopathy (18/24) were the most common presenting complaints. Over 80% (20/24) of patients, had involvement of the thoracic spine and more than 50% (13/24) had severe spasticity, being Nurick grade 4&5 at presentation. The various treatment modalities used were laminectomy with or without instrumented posterior fusion (10/24), corpectomy with instrumented fusion (10/24) and alcohol injection alone (4/24). Patients who were treated with surgery had significant clinical improvement at follow-up in both groups. Patients who underwent alcohol injection did not have any improvement in symptoms at follow-up. There was a change in our strategy in the later part of the series from a two staged anterior and posterior approach to a single staged posterior-only approach to address vertebral body disease with preoperative angioembolization. Conclusion Haemangiomas are benign lesions with locally aggressive behavior in some cases. Results of conservative approaches such as alcohol injection in management of these lesions are discouraging. Aggressive surgical decompression combined with preoperative adjuncts such as angioembolization with or without stabilization reduces intra operative blood loss and results in good neurological recovery even in patients with severe myelopathy.
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Affiliation(s)
- Ganesh Swaminathan
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | | | | | | | - Vinu Moses
- Department of Radiodiagnosis, Christian Medical College, Vellore, India
| | - Krishna Prabhu
- Department of Neurological Sciences, Christian Medical College, Vellore, India
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Diarra MD, Zhang Z, Wang Z, Yinwang E, Li H, Wang S, Lin P, Huang X, Ye Z. Surgical Options for Aggressive Vertebral Hemangiomas:A case series, literature review and treatment recommendations. J Bone Oncol 2023; 43:100515. [PMID: 38125609 PMCID: PMC10730854 DOI: 10.1016/j.jbo.2023.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose We retrospectively study twenty-nine surgical cases of aggressive vertebral hemangiomas (AVHs) with neurological deficits and extradural compression to determine the optimal surgical treatment strategy for AVHs at a single institution. Methods Patients with AVHs with neurological deficits who underwent partial tumor resection plus decompression with or without vertebroplasty (VP), and radiotherapy between 2010 and 2021 were included in this study. Clinical characteristics, surgical outcomes, and follow-up data of the patients were reviewed retrospectively. Results Twenty-nine AVH cases with neurological deficits and spinal instability were included in this study and treated surgically. The mean operation time of patients with decompression surgery plus VP (Groupe A) was 215.9 (120-265 min), shorter than that of decompression surgery without VP (Group B) 240.2 (120-320 min). Intraoperative blood loss was 273.3 (100-550 mL) in group A and 635.3 (200-1600 mL) in group B. In addition, a significant reduction in blood loss was observed in group A compared to the group B (p=0.0001). All patients experienced immediate pain relief and improvement in their neurological symptoms. Neurological function was assessed by the Frankel score, ASIA score, and the visual analogue scale (VAS) pain score decreased from 7.4 (4-9) to 1.3 (0-3). Of twenty-nine patients in this study, only 7% (2/29 patients) showed signs of recurrence. Conclusion Decompression plus VP achieve good tumor control and decrease surgical complication. Preoperative vascular embolization and VP can reduce intraoperative bleeding in the treatment of AVH surgery. Moreover, postoperative radiotherapy seems to be a good technique to prevent tumor recurrence.
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Affiliation(s)
- Mohamed Diaty Diarra
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Zengjie Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Zhan Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Eloy Yinwang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Hengyuan Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Shengdong Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Peng Lin
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Xin Huang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Zhaoming Ye
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
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Tonosu J, Yamaguchi Y, Higashikawa A, Watanabe K. Ethanol Sclerosis Therapy for Aggressive Vertebral Hemangioma of the Spine: A Narrative Review. J Clin Med 2023; 12:3926. [PMID: 37373622 DOI: 10.3390/jcm12123926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Vertebral hemangiomas of the spine are rare benign tumors. They occur primarily in the thoracic region and are often asymptomatic and found incidentally on radiological examination; however, some are symptomatic, aggressive, and gradually increase in size. Various therapeutic approaches have been proposed for their management. This study aimed to review the therapeutic management, focusing on ethanol sclerosis therapy. The PubMed database was searched from inception to January 2023 using the keywords "hemangioma", "spine OR vertebra", and "ethanol". Twenty studies were retrieved, including two letters. The first report of spinal therapy was published in 1994. Ethanol sclerosis therapy is effective in treating vertebral hemangiomas. It is performed independently or in combination with other techniques, such as vertebroplasty using cement and surgery. The therapy is performed under local or general anesthesia with fluoroscopic or computed tomography guidance. A total of 10-15 mL of ethanol is slowly injected via unilateral or bilateral pedicles. Complications of the therapy include hypotension and arrhythmia during the procedure, paralysis immediately after the procedure, and delayed compression fractures. This review could enable the refinement of knowledge regarding ethanol sclerosis therapy, which is a treatment option that could be adopted.
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Affiliation(s)
- Juichi Tonosu
- Department of Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki 211-8510, Kanagawa, Japan
| | - Yasuteru Yamaguchi
- Department of Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki 211-8510, Kanagawa, Japan
| | - Akiro Higashikawa
- Department of Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki 211-8510, Kanagawa, Japan
| | - Kenichi Watanabe
- Department of Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki 211-8510, Kanagawa, Japan
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11
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Kuo A, Ahorukomeye P, Gordon ZL. Aggressive thoracic vertebral hemangioma: case report and literature review. Spinal Cord Ser Cases 2023; 9:20. [PMID: 37210382 PMCID: PMC10199886 DOI: 10.1038/s41394-023-00577-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 04/14/2023] [Accepted: 05/11/2023] [Indexed: 05/22/2023] Open
Abstract
INTRODUCTION Vertebral hemangiomas are common and typically benign vascular lesions, with a prevalence of 10-12% in the general population and 2-3% in all spine tumors. A small subset of vertebral hemangiomas can be categorized as "aggressive" if they exhibit extraosseous expansion that compress the spinal cord, causing pain and various neurologic symptoms. This report details a case of aggressive thoracic hemangioma resulting in worsening pain and paraplegia to draw attention to this rare condition, including identification and treatment. CASE PRESENTATION In this case, we present a 39 year-old female with a history of progressively worsening pain and paraplegia caused by compression of the spinal cord from an aggressive thoracic vertebral hemangioma. Clinical presentation, imaging, and biopsies, confirmed the diagnosis. A combined surgical and endovascular treatment strategy was implemented, and the patient's symptoms improved. DISCUSSION Aggressive vertebral hemangioma is a rare condition that may cause symptoms that diminishes the quality of life, including pain and various neurological symptoms. Given the low number of such cases, and significant impact on lifestyle, it is beneficial to identify cases of aggressive thoracic hemangiomas to ensure timely and accurate diagnosis and help development of treatment guidelines. This case highlights the importance of identifying and diagnosing this rare but serious disease.
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Affiliation(s)
- Andy Kuo
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Peter Ahorukomeye
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
| | - Zachary L Gordon
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
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12
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Mousavi SR, Akbari S, Rasekhi A, Kazeminezhad A, Motlagh MAS, Taherpour S. A less aggressive approach to the treatment of aggressive vertebral hemangioma of the thoracic spine: A case report and literature review. Int J Surg Case Rep 2023; 105:108027. [PMID: 36965444 PMCID: PMC10073888 DOI: 10.1016/j.ijscr.2023.108027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/07/2023] [Accepted: 03/21/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Different treatments are available for aggressive vertebral hemangioma [AVH], but a consensus is yet to be reached about the best therapeutic approach. PURPOSE To explore the possibility that selecting a less aggressive therapeutic approach for AVH decreases the intraoperative and postoperative complications while providing similar clinical, radiographic, and disease-free survival results to more aggressive therapeutic methods. STUDY We report the case of an AVH of the thoracic spine at the T5 level, treated via perioperative selective arterial embolization plus surgical decompression via laminectomy and reconstruction with polymethylmethacrylate (PMMA) vertebroplasty. PATIENT The patient was a 17-year-old male referred to our center with the chief complaint of low back pain from two months earlier, without any response to analgesics, and with neurologic manifestations as paraparesis (one month) and progressive sphincter problems (one week). Upon imaging, the impression was an aggressive spinal tumor with cord compression. OUTCOME MEASURES After the operation, the patient's pain immediately improved, and his neurologic manifestations progressively improved. RESULTS The patient started walking with help about three weeks after the operation. Roughly six months later, he achieved a complete neurological recovery. At present, about two years following the operation, he has a normal life without any neurological problems. CONCLUSION Based on our experience with AVH, the selection of less aggressive therapeutic approaches such as perioperative diagnostic angiography and selective embolization decrease the intraoperative and postoperative complications like intraoperative bleeding and neurological injury, while achieving similar clinical, radiographic, and disease-free survival outcomes to more aggressive therapeutic methods.
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Affiliation(s)
- Seyed Reza Mousavi
- Department of Neurosurgery, Shiraz University of medical science, Shiraz, Iran; Shiraz Neuroscience Research Center, Shiraz University of medical science, Shiraz, Iran
| | - Somayeh Akbari
- Histomorphometry and Stereology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Rasekhi
- Department of Radiology, Shiraz University of medical science, Shiraz, Iran
| | - Ali Kazeminezhad
- Department of Neurosurgery, Peymanieh Hospital, Trauma Research Center, Jahrom University, Iran
| | | | - Sanaz Taherpour
- Department of Neurosurgery, Shiraz University of medical science, Shiraz, Iran.
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13
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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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14
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Sharma S, Kamal R, Rathi AK. Vertebral hemangioma - the current radiation therapy perspective. Rep Pract Oncol Radiother 2023; 28:93-101. [PMID: 37122908 PMCID: PMC10132198 DOI: 10.5603/rpor.a2023.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/06/2023] [Indexed: 05/02/2023] Open
Abstract
Vertebral hemangiomas are benign tumors of the spine, most often detected incidentally and on other instances, when signs and symptoms of the disease arise. About 10% of the population are affected worldwide with a female to male ratio of 2:1. The majority of these cases are asymptomatic and no intervention is generally required. Less often, back pain and neurological deficit may occur. Such hemangiomas are termed aggressive by the Enneking staging and warrant treatment. In this review, staging and diagnostics are discussed in detail followed by treatment options. Treatment options entail Surgical intervention, Percutaneous ethanol injection, radiofrequency ablation and Radiation Therapy. There are no set guidelines on preference or order of the treatment options. Further, in this review, studies favouring Radiation therapy regimes and their outcomes are elaborated.
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Affiliation(s)
- Shambhavi Sharma
- Department of Radiotherapy, Maulana Azad medical College, New Delhi, India
| | - Rose Kamal
- Department of Radiation Oncology, Amrita Institute of Medical Sciences and Research Centre, Faridabad, Haryana, India
| | - Arun Kumar Rathi
- Department of Radiotherapy, Maulana Azad medical College, New Delhi, India
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15
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Lisitsky IY, Lychagin AV, Zarov AY, Korkunov AL, Cherepanov VG, Vyzankin IA. [Total resection of aggressive hemangioma of thoracic spine: case report and literature review]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:92-97. [PMID: 37325831 DOI: 10.17116/neiro20238703192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The authors report total resection of aggressive hemangioma of Th7 vertebra in a patient with severe conduction disorders in the lower extremities. Total Th7 spondylectomy (Tomita procedure) was performed. This method provided simultaneous en bloc resection of the vertebra and tumor via the same approach, eliminate spinal cord compression and perform stable circular fusion. Postoperative follow-up period was 6 months. Neurological disorders were evaluated using the Frankel scale, pain syndrome - visual analogue scale, muscle strength - MRC scale. Pain syndrome and motor disorders in the lower extremities regressed in 6 months after surgery. CT confirmed spinal fusion without signs of continued tumor growth. Literature data on surgical treatment of aggressive hemangiomas are reviewed.
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Affiliation(s)
- I Yu Lisitsky
- Sechenov First Moscow State Medical University, Russia, Moscow
| | - A V Lychagin
- Sechenov First Moscow State Medical University, Russia, Moscow
| | - A Yu Zarov
- Sechenov First Moscow State Medical University, Russia, Moscow
| | - A L Korkunov
- Sechenov First Moscow State Medical University, Russia, Moscow
| | - V G Cherepanov
- Sechenov First Moscow State Medical University, Russia, Moscow
| | - I A Vyzankin
- Sechenov First Moscow State Medical University, Russia, Moscow
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16
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Brindisino F, Scrimitore A, Pennella D, Bruno F, Pellegrino R, Maselli F, Lena F, Giovannico G. Aggressive Vertebral Hemangioma and Spinal Cord Compression: A Particular Direct Access Case of Low Back Pain to Be Managed-A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13276. [PMID: 36293852 PMCID: PMC9603351 DOI: 10.3390/ijerph192013276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Hemangiomas are the most common benign tumours affecting the spine, with an incidence of 10-12% of the general population. Although most hemangiomas are asymptomatic, there are aggressive forms which can develop symptoms, leading patients to show signs of disability. This case report aims to highlight the importance of red flags screening, and to report the physiotherapist's clinical reasoning that led him to refer his patient to other healthcare professionals. This case also illustrated the pre- and post-surgical treatment of a specific low back pain case in a patient affected by aggressive vertebral hemangioma and spinal cord compression. The patient is a 52-year-old man, who reported intense pain in his sacral region about three months prior, which worsened while in sitting position. The physiotherapist proceeded with a complete medical history investigation and clinical examination. After an impaired neurological examination, the patient was referred to another health professional, who diagnosed multiple vertebral hemangiomas in the patient's lumbosacral tract. The therapeutic intervention included the patient's post-surgical rehabilitation following a vascular embolization. This case report shows the importance of proper patient screening. Indeed, during patients' assessment, it is paramount to recognize red flags and to investigate them appropriately. An early referral of patients with conditions that require the support and expertise of other professionals can lead to a timely diagnosis and avoid costly and unnecessary rehabilitation procedures. In this case, the interdisciplinary collaboration between physiotherapist and neurosurgeon was crucial in guiding the patient towards recovery.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Angelo Scrimitore
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Denis Pennella
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Francesco Bruno
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Raffaello Pellegrino
- Antalgic Mini-Invasive and Rehab-Outpatients Unit, Department of Medicine and Science of Aging, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy
- Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano, Switzerland
| | - Filippo Maselli
- Department of Human Neurosciences, University of Rome “Sapienza”, 00185 Rome, Italy
- Sovrintendenza Sanitaria Regionale Puglia INAIL, 70121 Bari, Italy
| | - Francesco Lena
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
- Department of Neurology, IRCCS INM Neuromed, 86077 Pozzilli, Italy
| | - Giuseppe Giovannico
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
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17
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Alsuwaihel M, El-Mughayyar D, MacLennan M, Attabib N. Undifferentiated presentation of unilateral agenesis of a cervical pedicle and a contiguous vertebral hemangioma: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE2232. [PMCID: PMC9379719 DOI: 10.3171/case2232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Unilateral agenesis of a cervical pedicle is a known rare entity that has been well described over the past 70 years. It is usually an incidental or minimally symptomatic presentation with no significant clinical repercussion. No previous report has described concurrent non-osseous developmental abnormalities alongside this unique pathology.
OBSERVATIONS
This case reported a cervical hemangioma with associated unilateral pedicle agenesis and an incidental finding of callosal dysgenesis and lipoma. The initial presentation consisted solely of persistent neck pain, with cervical radiography illustrating significant kyphotic deformity secondary to apparent anterolisthesis of C3-C4. The patient underwent a combined approach: anterior cervical corpectomy at C4-C5 with supplemental posterior fusion. The authors provided a review of the literature concerning developmental pedicle abnormalities and vertebral hemangioma. Pedicle agenesis is known to be associated with multiple pathologies, but the authors have not found evidence of a clinical paradigm consisting of a vertebral hemangioma in the presence of cervical pedicle agenesis, callosal dysgenesis, or callosal lipoma.
LESSONS
Careful evaluation of radiographs with appropriate subsequent multimodal imaging is key to identifying unique pathologies in the spine that complement a patient’s history and clinical findings. If multiple abnormalities are noted, a novel clinical etiology or syndrome must be considered.
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Affiliation(s)
- Mosaab Alsuwaihel
- Department of Neurosurgery, Horizon Health Network, Saint John, New Brunswick, Canada
| | - Dana El-Mughayyar
- Department of Neurosurgery, Horizon Health Network, Saint John, New Brunswick, Canada
- Department of Neurosurgery, Canada East Spine Centre, Saint John, New Brunswick, Canada; and
| | | | - Najmedden Attabib
- Department of Neurosurgery, Horizon Health Network, Saint John, New Brunswick, Canada
- Department of Neurosurgery, Canada East Spine Centre, Saint John, New Brunswick, Canada; and
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Radiosurgery for benign vertebral body hemangiomas of the spine: a systematic review and meta-analysis. World Neurosurg 2022; 164:97-105. [PMID: 35378316 DOI: 10.1016/j.wneu.2022.03.120] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Spinal vertebral hemangiomas (SVH) are the most common benign tumors of the spine. Here, we performed a systematic review and meta-analysis of radiosurgery (RS) for SVH. METHODS We reviewed manuscripts published between January 1990 and December 2020 on PubMed. Tumor control, pain relief and damage to surrounding tissues were evaluated with separate meta-analyses. This study was performed in accordance with the published Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twenty-three patients with 24 SVH were reported in 3 studies. RESULTS The follow-up ranged from 7.3 months to 84 months. A vast majority of lesions were located at dorsal level (n= 18, 75%). Twenty (83.3%) clinically presented with pain at initial discovery. Complete, partial and stable response after radiations were described in 45.7% (p< 0.001), 23.6% (p= 0.02) and 37.2% (p= 0.7) of the cases. Overall response was described in 94.1% (p= 0.7). No progressive disease was reported. Pain relief was achieved in 87.5% of patients (p= 0.2). Damage to surrounding tissue caused by irradiation was described in 22.3% (p= 0.02) of cases in only one study, in which there were delivered higher doses of radiation. CONCLUSIONS Radiosurgery is safe and effective for SVH. Pain relief in symptomatic patients is extremely high, while local control showed no progressive disease. Damage to surrounding tissues was reported in only one series and included osteitis, osteonecrosis or soft tissue injury after higher radiation doses.
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19
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Aksoy RA, Aksu MG, Korcum AF, Genc M. Radiotherapy for vertebral hemangioma: the single-center experience of 80 patients. Strahlenther Onkol 2022; 198:648-653. [PMID: 35278096 DOI: 10.1007/s00066-022-01915-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/20/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to evaluate the therapeutic effect of radiotherapy and to determine possible prognostic factors in patients with painful vertebral hemangioma. METHODS In the last two decades, 80 patients with vertebral hemangioma who received radiotherapy in our institute were evaluated in terms of pain response, treatment-related side effects, and prognostic factors. All patients were questioned 3 months after radiotherapy for the evaluation of pain response and were divided into three groups (complete response, partial response, and no change). Moreover, the visual analog scale (VAS) was used for pain response assessment in 46 patients. Pain status was assessed to detect recurrence at each clinical examination during the follow-up period. Possible prognostic factors such as gender, size of the hemangioma, location, multilevel involvement and additional musculoskeletal disease on pain response were analyzed. RESULTS In this study, 45 individuals had lesions in the lumbar spine, 28 in the thoracic, and 7 in the cervical region. Furthermore, 51 patients had additional musculoskeletal conditions such as disc herniation, degenerative diseases, spondylolisthesis, and compression fracture. Radiotherapy was performed with a median daily dose of 2 Gy and a median total dose of 40 Gy. Complete pain response occurred in 58.8% of patients, 26.2% of patients had partial pain response, and 15% of patients had no pain response. The overall response rate was 85%, and 7 patients showed recurrent pain symptoms in the overall response group at routine follow-up. Additional musculoskeletal disorders were found to be the only prognostic factor associated with pain response. The median follow-up time was 60 months. Secondary malignancy was not found in any of the patients in this short follow-up time. No acute or late radiation-associated side effects greater than grade II were observed. CONCLUSION To our best knowledge, this study is one of the largest single-institution radiotherapy series on vertebral hemangiomas reported to date. The obtained data support the efficacy and safety of radiotherapy in the treatment of painful vertebral hemangioma. Our study showed that additional musculoskeletal disease plays an important role in pain response. Other prognostic factors and treatment of vertebral hemangioma with stereotactic radiosurgery should be investigated in future studies.
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Affiliation(s)
- Rahmi Atil Aksoy
- Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey.
| | - Melek Gamze Aksu
- Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Aylin Fidan Korcum
- Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Mine Genc
- Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
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20
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Srinivasan G, Moses V, Padmanabhan A, Ahmed M, Keshava SN, Krishnan V, Joseph BV, Raju KP, Rajshekhar V. Utility of spinal angiography and arterial embolization in patients undergoing CT guided alcohol injection of aggressive vertebral hemangiomas. Neuroradiology 2021; 63:1935-1945. [PMID: 34427707 DOI: 10.1007/s00234-021-02788-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the role of spinal angiography and arterial embolization in avoiding spinal cord ischemia in patients undergoing CT-guided alcohol injection of aggressive vertebral hemangiomas. METHODS In this retrospective study, patients with vertebral hemangioma who underwent CT-guided direct alcohol injection between January 2007 and October 2018 were identified. Of 28 such patients, 26 had neurological deficits, and 2 had only back pain or radiculopathy. Direct alcohol injection without prior arterial embolization was done in 17 patients. Direct alcohol injection with prior arterial embolization was done in 11 patients. Clinical outcome was assessed immediately after the intervention and at follow-up. RESULTS Three patients, who underwent alcohol injection without trans-arterial embolization, had worsening of neurological deficits in the post procedure period due to spinal cord ischemia. No complications related to spinal cord ischemia were noted in the embolization group. There was no significant difference in the outcomes between the two groups if the three patients with complications are excluded (p = 0.34). CONCLUSION While CT-guided direct alcohol injection is effective in the management of symptomatic and aggressive vertebral hemangiomas, spinal angiography and trans-arterial embolization of the blood supply to the vertebral body hemangioma, prior to the direct transpedicular alcohol embolization of the lesion, improves the safety of the procedure.
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Affiliation(s)
| | - Vinu Moses
- Radiology, Christian Medical College, Vellore, 632004, India
| | | | - Munawwar Ahmed
- Radiology, Christian Medical College, Vellore, 632004, India
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21
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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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Spiessberger A, Dietz N, Arvind V, Nasim M, Gruter B, Nevzati E, Hofer S, Cho SK. Spondylectomy in the treatment of neoplastic spinal lesions - A retrospective outcome analysis of 582 patients using a patient-level meta-analysis. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:107-116. [PMID: 34194155 PMCID: PMC8214243 DOI: 10.4103/jcvjs.jcvjs_211_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/31/2021] [Indexed: 01/23/2023] Open
Abstract
This study aims at identifying predictors of postoperative complications, lesion recurrence, and overall survival in patients undergoing en bloc spondylectomy (EBS) for spinal tumors. For this purpose a systematic review of the literature was conducted and patient-level data extracted. Linear-regression models were calculated to predict postoperative complications, lesion recurrence and overall survival based on age, tumor etiology, surgical approach, mode of resection (extra- vs. intralesional), tumor extension, and number of levels treated. A total of 582 patients were identified from the literature: 45% of females, median age 46 years (5-78); most common etiologies were: sarcoma (46%), metastases (31%), chordoma (11%); surgical approach was anterior (2.5%), combined (45%), and posterior (52.4%); 68.5% underwent EBS; average levels resected were 1.6 (1-6); average survival was 2.6 years; Complication rate was 17.7%. The following significant correlations were found: postoperative complications and resection mode (Odds ratio [OR] 1.35) as well as number of levels treated (OR 1.35); tumor recurrence and resection mode (OR 0.78); 5-year survival and age (OR 0.79), tumor grade (OR 0.65), tumor stage at diagnosis (OR 0.79), and resection mode (OR 1.68). EBS was shown to improve survival, decreases recurrence rates but also has a higher complication rate. Interestingly, the complication rate was not influenced by tumor extension or tumor etiology.
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Affiliation(s)
- Alexander Spiessberger
- Department of Orthopedic Surgery, Icahn School of Medicine - Mount Sinai Hospital, NY, USA.,Department of Neurosurgery, Hofstra School of Medicine, North Shore University Hospital, NY, USA
| | - Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
| | - Varun Arvind
- Department of Orthopedic Surgery, Icahn School of Medicine - Mount Sinai Hospital, NY, USA
| | - Mansoor Nasim
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra Northwell, NY, USA
| | - Basil Gruter
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Edin Nevzati
- Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Silvia Hofer
- Department of Medical Oncology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Samuel K Cho
- Department of Orthopedic Surgery, Icahn School of Medicine - Mount Sinai Hospital, NY, USA
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IONESCU EV, ILIESCU MG, ZAMFIR Costică, DRĂGOI MF, CALOTA N, OBADA B, IONESCU AM, OPREA D. Challenges regarding rehabilitation treatment in a case of postpartum spastic paraparesis, secondary to a T9 vertebral fracture on the pathologicallybone operated -case report. BALNEO AND PRM RESEARCH JOURNAL 2021. [DOI: 10.12680/balneo.2021.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. Pregnancy is a well-known risk factor for asymptomatic hemangiomas discovered incidentally, becoming aggressive or symptomatic, most often in the third trimester of pregnancy, related to hemodynamic and endocrine changes that occur during pregnancy. Many patients experience incomplete spontaneous remission after birth. Material and method. We report the case of a 24-year-old woman, who presented for incomplete paraplegia, pain in the spine, instability of walking of the left lower limb, bilateral plantar paresthesia, possible walking with metal support. Results and discussions. The MRI performed identifies T9 vertebral fracture-compression on pathological bone, T10-T12 vertebral hemangiomas. Conclusions. In order to obtain favorable results, the patient benefited from the support and treatment of a multidisciplinary team: neurosurgeons, imagers, physical and rehabilitation medicine doctors and physiotherapists, and represented a real challenge regarding the complexity of the factors involved.
Keywords: hemangioma, rehabilitation, multidisciplinary team
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Affiliation(s)
- Elena Valentina IONESCU
- Balneal and Recovery Sanatorium Techirghiol, Constanta, Romania 2 Faculty of Medicine, Ovidius University, Constanţa ,România
| | - Mădălina Gabriela ILIESCU
- Balneal and Recovery Sanatorium Techirghiol, Constanta, Romania 2 Faculty of Medicine, Ovidius University, Constanţa ,România
| | | | | | - Nicoleta CALOTA
- Balneal and Recovery Sanatorium Techirghiol, Constanta, Romania 2 Faculty of Medicine, Ovidius University, Constanţa ,România
| | - Bogdan OBADA
- Faculty of Medicine, Ovidius University, Constanţa ,România
| | | | - Doiniţa OPREA
- Faculty of Medicine, Ovidius University, Constanţa ,România
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Shamhoot EA, Balaha AM, Ganna AA. Role of Combined Vertebroplasty and Spinal Decompression in the Management of Aggressive Vertebral Hemangiomas. Asian J Neurosurg 2021; 15:919-925. [PMID: 33708663 PMCID: PMC7869295 DOI: 10.4103/ajns.ajns_291_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/04/2020] [Accepted: 09/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background: There are different surgical modalities designed to manage aggressive vertebral hemangioma (VH) that causes neurological symptoms. The selection of the best approach is still controversial. It is crucial to safely achieve neurological recovery with the elimination of the risk of recurrence. The combined use of surgical decompression and vertebroplasty is one of the surgical modalities that are used to manage these cases. Patients and Methods: From January 2012 to January 2019, nine patients with aggressive VH were retrospectively included in the study. All of them were operated upon using combined surgical decompression and vertebroplasty. We evaluated all the patients preoperatively, immediate postoperative, 1 month, and 12 months later. Clinical and radiological outcomes were assessed. Results: Affected spinal levels were dorsal in six cases and lumbar in three cases. There was no postoperative worsening of the preoperative neurological status. For the cases presented with sciatica, the mean VAS score has dropped from 8.33 preoperatively to 2.67 postoperatively. One month later, all of them are free from the radicular pain. For the cases presented with myelopathy, they regain their motor power in both lower limbs over a period of 4 weeks with a mean Nurick grade of 1.17. The postoperative radiological studies revealed near total occlusion of the VH with the maintenance of the vertebral body height. No clinical or radiological signs of spinal instability or recurrence are observed over the period of follow-up. Conclusions: The combined use of surgical decompression and vertebroplasty is considered a safe and effective modality in the management of aggressive VHs.
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Affiliation(s)
| | | | - Ahmed Atef Ganna
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Egypt
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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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26
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Konbaz FS, Althunayan TA, Alzahrani MT, Altawayjri IA, Jawadi TA, Alhelal F, Abalkhail M, Aleissa S. Aggressive L3 vertebral hemangioma coexisting with adult thoracolumbar scoliosis: Case report. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2021; 5:100040. [PMID: 35141607 PMCID: PMC8819962 DOI: 10.1016/j.xnsj.2020.100040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 11/28/2022]
Abstract
Vertebral hemangiomas are benign vascular tumors that are commonly asymptomatic. A low percentage might become aggressive; however, they are not known to be associated with scoliosis. We present a case of a third lumbar vertebral lesion coexisting with a moderate thoracolumbar scoliosis. The patient's initial presentation was back pain with bilateral lower limb radiculopathy and neurogenic claudication. Diagnosis was established using CT and MRI, which showed classical findings of an aggressive vertebral hemangioma. The patient underwent Partial hemangioma excision and scoliosis correction, with satisfactory outcome at 1 year follow up.
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Thoracic spine hemangioma causing rapidly progressive myelopathy and mimicking a malignant tumor: A case report. Radiol Case Rep 2021; 16:938-941. [PMID: 33659033 PMCID: PMC7890091 DOI: 10.1016/j.radcr.2021.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 11/23/2022] Open
Abstract
Vertebral hemangiomas are common benign tumors that are mostly asymptomatic and are discovered incidentally. Only 0.9–1.2% of all vertebral hemangiomas, termed aggressive vertebral hemangiomas, expand to cause pain and neural compression. We present an extremely rare case of a 49-year-old woman who had an aggressive vertebral hemangioma of the thoracic spine that caused rapidly progressive myelopathy with remarkable irregular extraosseous bone proliferation, which mimicked a malignant vertebral tumor. In this case, despite the lesion's hostile appearance during imaging, the pathological diagnosis was benign and symptom-based surgical treatment with posterior decompression and stabilization provided good clinical outcomes during the postoperative 18 months follow-up period. In this case, despite the use of standard imaging modalities (radiograph, CT, and MRI), making a preoperative imaging diagnosis of an aggressive vertebral hemangioma was difficult, and although aggressive vertebral hemangiomas with atypical radiological features are rare, they should be considered as a differential diagnosis.
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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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Degrieck B, Defreyne L. Cone-Beam CT-Guided Selective Intralesional Ethanol Injection of the Compressive Epidural Components of Aggressive Vertebral Haemangioma in Progressive and Acute Myelopathy: Report of 2 Cases. J Vasc Interv Radiol 2020; 31:1508-1510. [PMID: 32800666 DOI: 10.1016/j.jvir.2020.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Bert Degrieck
- Department of Vascular and Interventional Radiology, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium
| | - Luc Defreyne
- Department of Vascular and Interventional Radiology, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium
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Qiu B, Joo P, Ajabnoor R, Boyce B, Mesfin A. Surgical management of aggressive hemangiomas of the spine. J Clin Neurosci 2020; 78:67-72. [PMID: 32620473 DOI: 10.1016/j.jocn.2020.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 04/30/2020] [Accepted: 06/09/2020] [Indexed: 12/25/2022]
Abstract
Our objective is to describe the surgical management and outcomes following surgical intervention for aggressive spine hemangiomas. Patients from 2005 to 2018 with an aggressive hemangioma of the cervical, thoracic, lumbar spine and sacrum treated surgically at a tertiary referral academic medical center were included in this study. The hospital pathology department database was used to identify patients with a diagnosis of aggressive hemangioma. Patient demographics, medical history, operative procedure, adjunct treatment, early and late complications, and recurrence were analyzed using the Fischer exact test with significance set at p < 0.05 Ten patients met inclusion criteria for the study. The average follow up was 11 months. Eight out of ten patients had aggressive hemangioma of the thoracic spine. Seven of the ten patients presented with back or leg pain. The most common surgery was laminectomy at the site of the lesion (70%). 40% of patients underwent a spinal fusion, with two of these patients receiving concurrent intra-operative vertebroplasty. Three patients underwent post-operative radiation therapy. Five complications were noted among three individuals. There were three perioperative complications, deep venous thrombosis, renal insufficiency, one surgical site infection, and two postoperative complications, both revisions. There were no recurrences. Surgical intervention for aggressive spine hemangiomas is an effective treatment with relatively low complication and recurrence rates.
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Affiliation(s)
- Bowen Qiu
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Peter Joo
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Rana Ajabnoor
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Brendan Boyce
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Addisu Mesfin
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States.
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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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Preoperative Endovascular Embolisation of the Symptomatic Hemangioma in 7th Thoracic Vertebrae: Case Report. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020. [DOI: 10.2478/sjecr-2018-0065] [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
Abstract
Although, as asymptomatic, they appear in about 10-12% of the worldwide population, vertebrae hemangiomas are symptomatic in about 0.9-1.2% of all the cases.
We showed the case of the symptomatic hemangioma in the 7th thoracic vertebrae in 67 year old patient, that was successfully preoperative embolised. Magnetic resonance imaging (MRI) detected the tumor in the body of 7th vertebrae with mass effect on the anterior aspect of the spinal cord. Multidetector computed tomography (MDCT) imaging describes this tumor as hemangioma that is in the body of the Th7 vertebrae and in the both pedicules. We performed selective and supraselective spinal angiography which showed pathological vascularisation of the tumor, and then the tumor was embolised. The control angiography detected the reduction of the tumor blood vessels, as a sign of the successful embolisation. Ten days after embolisation, the patient went through corporectomia of the Th7 and the stabilization of the thoracic spine was performed. Intraoperative blood transfusion in our patient was 930 mL, while expected blood transfusion during the surgical intervention without preoperative embolisation is about 1600 mL.
Method of choice in conditions with neurological compressive symptoms caused by vertebral hemangioma is surgery for the decompression of the nerve structures. Embolisation of aggressive vertebral hemangioma is recommended and preoperatively performed for the intraoperative hemorrhage reduction and decreasing of intraoperative complications.
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Surgical Management and Adjuvant Therapy for Patients With Neurological Deficits From Vertebral Hemangiomas: A Meta-Analysis. Spine (Phila Pa 1976) 2020; 45:E99-E110. [PMID: 31365517 DOI: 10.1097/brs.0000000000003181] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVE To understand the benefits and limitations of surgical management and adjuvant therapies for patients presenting with neurological deficits from vertebral hemangiomas (VH). SUMMARY OF BACKGROUND DATA VH is the most common benign spine tumor but rarely causes symptoms. Patients with back pain alone are treated with conservative management (kyphoplasty and radiation therapy), while those with neurological deficits require complex multi-modal treatment plans. METHODS A PubMed literature search for "symptomatic vertebral hemangioma with spinal cord compression" identified 47 articles. From these articles and their references, 19 observational studies on patients who underwent surgery for VH met inclusion criteria. Meta-analyses were performed comparing outcomes of the surgical and adjuvant therapies using Stata13 software. For those with insufficient data for meta-analyses, descriptive analyses of variables were completed. RESULTS One hundred ninety seven surgical cases of VH with neurologic deficits were identified. Surgery provided a complete remission of symptoms in 84% of patients, however 18% of patients had recurrence of hemangioma. Adjuvant interventions included radiation, embolization, and kyphoplasty. Radiation therapy (XRT) was associated with a lower recurrence rate and an increase in minor transient adverse effects. Preoperative embolization performed in 98 patients was associated with improved symptoms, reduced complications, lower recurrence rate, less blood loss, and higher incidence of pathologic vertebral fractures. Meta-analyses did not yield statistically significant results, likely due to the heterogeneity amongst the studies and small sample sizes, but the results compiled together provide insight on potential benefits of preoperative embolization for symptomatic relief and reduced risk of recurrence with XRT that deserves further study. CONCLUSION For patients with neurologic deficits from spinal cord or nerve root compression, surgery provides improvement in symptoms. Recurrence of VH and symptoms refractory to surgery can be further reduced by adjuvant therapies such as embolization, kyphoplasty, and radiation with some unique risks to each therapy. LEVEL OF EVIDENCE 2.
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Surgical Management of Enneking Stage 3 Aggressive Vertebral Hemangiomas With Neurological Deficit by One-stage Posterior Total En Bloc Spondylectomy: A Review of 23 Cases. Spine (Phila Pa 1976) 2020; 45:E67-E75. [PMID: 31404054 DOI: 10.1097/brs.0000000000003192] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Clinical case series. OBJECTIVE The aim of this study was to describe the treatment of aggressive vertebral hemangiomas (VHs) with neurological deficit treated with total en bloc spondylectomy (TES) in a single institute. SUMMARY OF BACKGROUND DATA Despite increasing utilization of surgery to treat aggressive VHs, owing to the rarity, the diagnosis and treatment protocols of aggressive VHs are still questionable and disputable. METHODS All patients with Enneking stage 3 aggressive thoracic or lumbar VHs with neurological deficit and treated with TES from January 2005 to January 2013 were included. Clinical characteristics and surgery outcomes of patients, including Tomita classification, operation time, blood loss, pre- and postoperative American Spinal Injury Association (ASIA) impairment scale, visual analogue score (VAS), and Spinal Instability Neoplastic Score (SINS), were retrospectively reviewed. RESULTS A total of 23 VHs patients were enrolled in this study, including 17 in the thoracic spine and six in the lumbar spine. All patients suffered neurological deficits caused by direct spinal cord compression with or without associated mechanical instability. The average SINS score was 9.78 ± 1.51. The mean operation time of patients with preoperative embolization was 426.6 ± 104.3 minutes and the mean blood loss was 1883.3 ± 932.1 mL. There were no technical difficulties or serious complications. After surgery, all patients recovered to ASIA-E levels. The VAS pain score decreased from 8.0 ± 0.9 to 2.8 ± 0.8 (P < .05). CONCLUSION TES is a good treatment option for patients with aggressive VHs with bony destruction and neurological deficit. LEVEL OF EVIDENCE 4.
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Rapidly Progressive Myelopathy Caused by Aggressive Vertebral Hemangioma. Case Rep Orthop 2019; 2019:8927310. [PMID: 31827961 PMCID: PMC6885279 DOI: 10.1155/2019/8927310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/08/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Vertebral hemangiomas are the most common benign tumors of the spine, having an incidence of 10-12% in the general population. They are asymptomatic, incidental findings in the vast majority of patients; however, in rare cases, they can expand to cause neural compression. Aggressive lesions of this sort are most commonly found in the thoracic spine, and expansion leads to the subacute development of myelopathy. Case Report The authors report a rare case of aggressive vertebral hemangioma at the T1 vertebral body which caused rapidly progressive myelopathy over the course of 7 days. Clinical and radiological findings are shown as well as surgical management of the lesion. The patient regained the ability to ambulate, and there was no evidence of disease recurrence at 2-year follow-up. Conclusions Although aggressive vertebral hemangiomas are a rare cause of myelopathy, they must be kept in mind in the differential diagnosis of cord compressive lesions. In this case, contrary to most, the expansion of the hemangioma led to rapid development of neurological decline necessitating urgent surgical intervention.
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Huang Y, Xu W, Chen Q, Lan Z. Treatment of Typical Enneking Stage 3 Thoracic Aggressive Vertebral Hemangiomas with Pain and Neurologic Deficits: Results After at Least 36 Months of Follow-Up. World Neurosurg 2019; 134:e642-e648. [PMID: 31689570 DOI: 10.1016/j.wneu.2019.10.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the efficiency of a comprehensive treatment strategy for patients with Enneking stage 3 thoracic aggressive vertebral hemangioma (AVH). METHODS A retrospective analysis of radiographic and clinical outcomes was performed for 17 patients who received treatment for Enneking stage 3 thoracic AVH accompanied by pain and neurologic deficits between January 2010 and February 2015. A visual analog scale (VAS) was used to clinically evaluate the level of pain. Neurologic examinations were performed to assess the patients' sensory symptoms, motor deficits, and Frankel grade. RESULTS The average operative time was 181.8 ± 37.1 minutes, and the average intraoperative blood loss was 1226.5 ± 151.2 mL (range, 900-1450 mL). All patients underwent preoperative embolization to minimize intraoperative blood loss. All patients experienced immediate pain relief and resolution of their neurologic symptoms. All 17 patients achieved Frankel grade D at the final follow-up; moreover, they reported that their pain was relieved (mean VAS score, 2.82 ± 0.81; P < 0.05) and their neurologic deficits had resolved. No surgery-related complications were noted. No patients exhibited signs of recurrence. CONCLUSIONS We recommend a comprehensive treatment strategy for patients with Enneking stage 3 thoracic AVH that includes preoperative embolization, vertebroplasty, posterior decompression, and internal fixation. We recommend that absorbable gelatin sponge particles be used for intraoperative embolization prior to the injection of bone cement, which may significantly reduce intraoperative bleeding, operative time, and occurrence of surgery-related complications.
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Affiliation(s)
- Yuming Huang
- Orthopedics Department, Fuzhou Second Hospital affiliated to Xiamen University, Fuzhou, China
| | - Weihong Xu
- Department of Spine Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qing Chen
- Department of Spine Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhibin Lan
- Spinal Surgery Department, Quanzhou Orthopedic-Traumatological Hospital of Fujian Traditional Chinese Medicine University, Quanzhou, China.
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Okada E, Matsumoto M, Nishida M, Iga T, Morishita M, Tezuka M, Mukai K, Kobayashi E, Watanabe K. Epithelioid Hemangioma of the Thoracic Spine: A Case Report and Review of the Literature. J Spinal Cord Med 2019; 42:800-805. [PMID: 29065791 PMCID: PMC6830232 DOI: 10.1080/10790268.2017.1390032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Context: Osseous epithelioid hemangioma is uncommon, and reports of epithelioid hemangiomas of the spine are especially rare.Study Design: Case report.Findings: A 43-year-old male was referred to our department with progressive gait disturbance. CT scans showed a lucent mass in the vertebral body at the T3 level. MRI of the thoracic spine showed a strongly enhanced mass compressing the spinal cord. The patient underwent laminectomy from T2 to T4, debulking of the tumor, and posterior fusion from T1 to T5. After the operation, the patient's neurological status improved significantly, and he was able walk without assistance. Histological examination determined that the tumor was an epithelioid hemangioma. The patient was treated with 40 Gy radiation for local control of the tumor. The patient could walk without difficulty 12 months after the surgery.Conclusion: This is a rare example of an epithelioid hemangioma that developed in the thoracic spine and compressed the spinal cord, and was treated successfully.
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Affiliation(s)
- Eijiro Okada
- Department of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic surgery, Keio University, Tokyo, Japan
| | - Mitsuhiro Nishida
- Department of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Takahito Iga
- Department of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Midori Morishita
- Department of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Masaki Tezuka
- Department of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Kiyoshi Mukai
- Department of Diagnostic Pathology, Saiseikai Central Hospital, Tokyo, Japan
| | - Eisuke Kobayashi
- Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic surgery, Keio University, Tokyo, Japan.,Correspondence to: Kota Watanabe, M.D., Ph.D., Dept. of Orthopaedic Surgery, Keio University, Shinanomachi 35, Shinjuku-ku, Tokyo #160-8582, Japan, E-mail:
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Sung KS, Choi HJ, Choi JH, Kwon YM, Song YJ, Choi SS, Kim KU. Hypofractionated stereotactic radiosurgery for aggressive vertebral haemangioma and useful follow-up imaging modality: case report and review of the literature. Br J Neurosurg 2019:1-5. [DOI: 10.1080/02688697.2019.1648756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Kyoung Su Sung
- Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
- Novalis Radiosurgery Center, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Hong-Jun Choi
- Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Jae-Hyung Choi
- Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Young-Min Kwon
- Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Young Jin Song
- Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
- Novalis Radiosurgery Center, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Sun-Seob Choi
- Department of Radiology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Ki-Uk Kim
- Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
- Novalis Radiosurgery Center, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
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Wang B, Zhang L, Yang S, Han S, Jiang L, Wei F, Yuan H, Liu X, Liu Z. Atypical Radiographic Features of Aggressive Vertebral Hemangiomas. J Bone Joint Surg Am 2019; 101:979-986. [PMID: 31169574 DOI: 10.2106/jbjs.18.00746] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Vertebral hemangioma (VH) is one of the most common benign spinal tumors and can be aggressive in some cases. While most aggressive VHs have typical radiographic features, including vertical striations, a honeycomb appearance, and/or a "polka-dot sign" in computed tomography (CT) scans, cases with atypical features might complicate diagnosis. This study aimed to determine the range and frequency of these atypical features. METHODS In this retrospective study, to identify the typical and atypical features of aggressive VH, pretreatment CT and magnetic resonance imaging (MRI) were reviewed retrospectively by 1 radiologist and 1 orthopaedic surgeon. Percutaneous biopsies were performed to confirm the VH in atypical cases. RESULTS A total of 95 patients with aggressive VHs were treated in our hospital from January 2005 to December 2017. Thirty-four (36%) of the lesions showed at least 1 atypical radiographic feature: 16 patients (17%) had a vertebral compression fracture, 11 patients (12%) had expansive and/or osteolytic bone destruction without a honeycomb appearance and/or "polka-dot sign", 11 patients (12%) had obvious epidural osseous compression of the spinal cord, 12 patients (13%) had involvement of >1 segment, 9 patients (10%) had a VH centered in the pedicle and/or lamina, and 8 patients (8%) had atypical MRI signals. Forty-three patients underwent percutaneous biopsies, which had an accuracy of 86%. CONCLUSIONS Based on radiographic analysis, aggressive VH can be classified as typical or atypical. More than one-third of aggressive VH lesions may have at least 1 atypical feature. CT-guided biopsies are indicated for these atypical cases.
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Affiliation(s)
- Ben Wang
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China.,Department of Pathology (S.Y.), Peking University Health and Science Center (B.W.), Beijing, China
| | - Lihua Zhang
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Shaomin Yang
- Department of Pathology (S.Y.), Peking University Health and Science Center (B.W.), Beijing, China
| | - Songbo Han
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Liang Jiang
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Feng Wei
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Huishu Yuan
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Xiaoguang Liu
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Zhongjun Liu
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
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Prabhuraj AR, Mishra A, Mishra RK, Pruthi N, Saini J, Arvinda HR. Per-operative glue embolization with surgical decompression: A multimodality treatment for aggressive vertebral haemangioma. Interv Neuroradiol 2019; 25:570-578. [PMID: 31060417 DOI: 10.1177/1591019919842849] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The aim of this study is to share our experience in per-operative embolization of aggressive vertebral haemangioma and to compare the surgical outcome with existing modalities of management. BACKGROUND Vertebral haemangioma accounts for 12% of benign lesions of the vertebral column detected incidentally. Rarely they may enlarge, cause pain and neurological deficit because of spinal cord compression, vertebral body or arch expansion, or pathological fracture. Treatment options for symptomatic vertebral haemangioma include pre-operative transarterial embolization, surgical excision, radiotherapy, and percutaneous injection of alcohol or methyl methacrylate. We present our experience of per-operative glue embolization for aggressive (Enneking stage 3) vertebral haemangiomas. MATERIALS AND METHODS We describe five patients with symptomatic vertebral haemangioma at the dorsal level who underwent per-operative glue embolization. After initial laminectomy, a tumorogram was obtained under fluoroscopic guidance through direct contrast injection via spinal needle inserted through the pedicles of vertebra at the involved level. Varied concentration of glue was injected via the same spinal needle. All patients underwent surgical decompression of the intraspinal epidural component in the same sitting along with posterior spinal stabilization of the adjacent levels in two patients. RESULTS In all five patients, complete embolization of the tumour was possible per-operatively through the transpedicular approach along with adjunctive surgical decompression, and the blood loss was significantly less. Clinical follow-up of these patients at 12-48 months showed reduction in size of the epidural component, relief of cord compression, and significant improvement in their neurological deficits with no recurrence. CONCLUSION We conclude that per-operative embolization is a safe and efficacious adjunctive procedure with surgical decompression with or without spinal stabilization for the treatment of symptomatic vertebral haemangiomas.
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Affiliation(s)
- A R Prabhuraj
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Dharmaram, India
| | - Ajit Mishra
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Dharmaram, India
| | - Rakesh Kumar Mishra
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Dharmaram, India
| | - Nupur Pruthi
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Dharmaram, India
| | - Jitender Saini
- Department of Neuroimaging and interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - H R Arvinda
- Department of Neuroimaging and interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
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An ethical dilemma: how to treat a symptomatic pediatric vertebral hemangioma? CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Girardo M, Zenga F, Bruno LL, Rava A, Massè A, Maule M, Fusini F. Treatment of Aggressive Vertebral Hemangiomas with Poly Vinyl Alcohol (PVA) Microparticles Embolization, PMMA, and Short Segment Stabilization: Preliminary Results with at Least 5 Years of Follow-up. World Neurosurg 2019; 128:e283-e288. [PMID: 31028979 DOI: 10.1016/j.wneu.2019.04.138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/14/2019] [Accepted: 04/15/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Vertebral hemangiomas (VHs) are the most common incidental lesions of vertebral body, but they are very challenging to treat if they become symptomatic. Several treatments have been proposed but none was superior to others. The aim of this study is to analyze blood loss and long-term clinical and neurological results of aggressive VHs treated with arterial embolization the day before operation, followed by vertebroplasty, posterior decompression, and short segment stabilization. METHODS Ten patients (4 males and 6 females) were treated for aggressive VHs with polyvinyl alcohol microparticles embolization, posterior short segment stabilization, and poly methyl methacrylate. Clinical and neurological outcomes were assessed with visual analog, Nurick, and American Spinal Injury Association (ASIA) scales. RESULTS At last follow-up mean, visual analog scale was 1.8 ± 1.3, with a significant difference with preoperative values (P = 0.00018). Neurological deficits persisted in 4 patients (ASIA scale: C in 1 patient [10%], D in 3 patients [30%]), but they improved from baseline in all cases. Also, Nurick scale rating improved in all patients (0 in 3 patients [30%], 1 in 4 patients [40%], 2 in 2 patients [20%], and 3 in the last one [10%]). A statistically significant difference between pre- and postoperative values was observed for both scores (ASIA, P = 0.0102; Nurick, P = 0.026). Relapse of pathology was recorded in 2 patients. CONCLUSIONS Polyvinyl alcohol microparticles embolization, short segment fixation, and vertebroplasty is an effective treatment option for aggressive VHs, with a fast surgical time, poor blood loss, and improvement of preoperative clinical and neurological outcomes.
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Affiliation(s)
- Massimo Girardo
- Spine Surgery Unit, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesco Zenga
- Department of Neurosurgery, Molinette Hospital, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Laura Lorien Bruno
- Spine Surgery Unit, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Alessandro Rava
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
| | - Alessandro Massè
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Milena Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
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Hans EC, Dudley RM, Watson AT, Chalkley M, Foss KD, Bancroft A, Prescott DM. Long-term outcome following surgical and radiation treatment of vertebral angiomatosis in a cat. J Am Vet Med Assoc 2018; 253:1604-1609. [DOI: 10.2460/javma.253.12.1604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Wang B, Jiang L, Liu XG, Wei F, Liu ZJ. Letter to the editor regarding "Long term outcome of treatment of vertebral body hemangiomas with direct ethanol injection and short segment stabilization" by Chandra et al. Spine J 2018; 18:2370-2371. [PMID: 30551847 DOI: 10.1016/j.spinee.2018.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Ben Wang
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China; Peking University Health and Science Center, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Liang Jiang
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China.
| | - Xiao Guang Liu
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Feng Wei
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Zhong Jun Liu
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China.
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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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Wang B, Meng N, Zhuang H, Han S, Yang S, Jiang L, Wei F, Liu X, Liu Z. The Role of Radiotherapy and Surgery in the Management of Aggressive Vertebral Hemangioma: A Retrospective Study of 20 Patients. Med Sci Monit 2018; 24:6840-6850. [PMID: 30259906 PMCID: PMC6180950 DOI: 10.12659/msm.910439] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Vertebral hemangioma is usually a benign and asymptomatic tumor of blood vessels, but can be aggressive (symptomatic) with expansion, pain, and spinal cord compression. The aim of this study was to review the effects of radiotherapy, surgery, and other treatment approaches in patients with aggressive vertebral hemangioma. Material/Methods Retrospective clinical review included 20 patients who underwent radiotherapy as their first-line treatment for aggressive vertebral hemangioma with mild or slowly developing neurological deficit. External radiation was divided into 20–25 fractions with a total dose of 40–50 Gy. Minimum clinical follow-up after treatment was 20 months. Results The 20 patients included eight men and 12 women (mean age, 46.6 years), with aggressive vertebral hemangioma located in the cervical, thoracic, and lumbar vertebrae in four, 14, and two patients, respectively. Following radiotherapy treatment, 65.0% of patients (13/20) were symptom-free, without recurrence or malignant transformation at the time of last clinical follow-up (average, 75.2 months). Due to minor post-radiation vertebral re-ossification, two of the 13 patients who were initially symptom-free after radiotherapy requested percutaneous vertebroplasty. A further seven patients required surgery after radiotherapy, due to increasing neurological deficit in three patients, and persistent neurological deficit in four patients. At the last follow-up (average, 63.6 months), six patients were symptom-free, and one patient still had slight residual symptoms. Conclusions Radiotherapy was a safe and effective treatment choice for aggressive vertebral hemangioma, but in case with severe spinal cord compression and neurological deficit, surgical intervention was required.
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Affiliation(s)
- Ben Wang
- Department of Orthopaedic, Peking University Third Hospital, Beijing, China (mainland).,Peking University Health and Science Center, Beijing, China (mainland)
| | - Na Meng
- Department of Radiotherapy, Peking University Third Hospital, Beijing, China (mainland)
| | - Hongqing Zhuang
- Department of Radiotherapy, Peking University Third Hospital, Beijing, China (mainland)
| | - Songbo Han
- Department of Radiology, Peking University Third Hospital, Beijing, China (mainland)
| | - Shaomin Yang
- Department of Pathology, Peking University Third Hospital, Beijing, China (mainland)
| | - Liang Jiang
- Department of Orthopaedic, Peking University Third Hospital, Beijing, China (mainland)
| | - Feng Wei
- Department of Orthopaedic, Peking University Third Hospital, Beijing, China (mainland)
| | - Xiaoguang Liu
- Department of Orthopaedic, Peking University Third Hospital, Beijing, China (mainland)
| | - Zhongjun Liu
- Department of Orthopaedic, Peking University Third Hospital, Beijing, China (mainland)
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A novel surgical technique for aggressive vertebral hemangiomas. Neurocirugia (Astur) 2018; 30:233-237. [PMID: 30266245 DOI: 10.1016/j.neucir.2018.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/13/2018] [Indexed: 11/23/2022]
Abstract
Vertebral hemangiomas are relatively common, but those causing spinal cord compression are rare. A 19-year-old male presented with thoracic back pain. The neurologic examination was normal and radiological examinations demonstrated an aggressive vertebral hemangioma centered within the T11 vertebral body. Damaged vertebral bone and soft tissue components of the mass were observed in the epidural space. Surgery was performed using a new technique involving radiofrequency ablation, injection of a hemostatic agent (FLOSEAL, Baxter, USA), and bone autograft placement in the affected vertebral body. There were no complications intra- or postoperatively, and the patient's back pain resolved completely during the postsurgical period. Bleeding is a serious issue in cases of aggressive vertebral hemangioma. This new technique provides improved bleeding control and strengthens the affected vertebra through autograft placement.
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Gangi A, Proust F. Multimodal management of vertebral hemangioma. Neurochirurgie 2018; 64:279-280. [DOI: 10.1016/j.neuchi.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 03/11/2018] [Accepted: 04/03/2018] [Indexed: 10/14/2022]
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Kaoudi A, Capel C, Chenin L, Peltier J, Lefranc M. Robot-Assisted Radiofrequency Ablation of a Sacral S1-S2 Aggressive Hemangioma. World Neurosurg 2018; 116:226-229. [DOI: 10.1016/j.wneu.2018.05.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
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