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Park DJ, Hori YS, Nernekli K, Persad AR, Tayag A, Ustrzynski L, Emrich SC, Hancock SL, Chang SD. Stereotactic radiosurgery for facial nerve hemangioma: Case report and systematic review. J Clin Neurosci 2024; 126:21-25. [PMID: 38823231 DOI: 10.1016/j.jocn.2024.05.023] [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: 03/24/2024] [Revised: 05/04/2024] [Accepted: 05/21/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Facial nerve hemangiomas (FNHs) are rare tumors that primarily occur near the geniculate ganglion in the temporal bone. Despite their rarity, they can cause significant facial nerve dysfunction. The optimal management approach for FNHs remains uncertain, with surgery being the mainstay but subject to debate regarding the extent of resection and preservation of the facial nerve. METHODS Systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We queried the PubMed/Medline (accessed on 5 March 2024) electronic database using combinations of the following search terms and words text: "geniculate ganglion hemangioma", "ganglional hemangioma", "hemangioma of the facial nerve", "facial hemangioma", and "intratemporal hemangioma". RESULTS We identified a total of 30 literatures (321 patients). The most common site involved for the facial nerve hemangioma was the geniculate ganglion area followed by internal auditory canal, tympanic segment, labyrinthine segment and mastoid involvement. All patients were treated with conservative management or surgery. We report a 48-year-old female patient with HB grade 2 facial palsy and hemifacial spasm underwent SRS using Cyberknife technology. The treatment targeted the FNH in the left internal acoustic canal near the geniculate ganglion. Six months post-treatment, clinical improvement was evident, and lesion control was confirmed in a follow-up brain MRI. CONCLUSION The rarity of FNHs contributes to the lack of consensus on optimal management. This illustrative case demonstrates the feasibility of SRS as a standalone treatment for FNHs.
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Affiliation(s)
- David J Park
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Yusuke S Hori
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Kerem Nernekli
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Amit R Persad
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Armine Tayag
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Louisa Ustrzynski
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Sara C Emrich
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Steven L Hancock
- Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, United States.
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Patel AA, Lilly D, Chao ST, Benzel E, Subramaniam G, Krishnaney A, Suh JH, Angelov L. Effective and Successful Control of Symptomatic Vertebral Hemangiomas With Epidural Extension Using Stereotactic Spine Radiosurgery. Neurosurgery 2024:00006123-990000000-01132. [PMID: 38713900 DOI: 10.1227/neu.0000000000002947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/16/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES We present our experience in the management of symptomatic vertebral hemangiomas with epidural extension (SVHEE) using spine stereotactic radiosurgery (SSRS). METHODS An Institutional Review Board approved retrospective review of all SVHEE patients treated with SSRS at our institution (2007-2022) was performed. Baseline patient demographics, clinical presentation, lesion volume, and Bilsky grade (to directly evaluate the epidural component) were determined. Clinical and radiographic response and treatment outcomes were subsequently evaluated at first (∼6 months) and final follow-up. RESULTS Fourteen patients with SVHEE underwent SSRS (16-18 Gy/1-fraction); the mean follow-up was 24 months. The median lesion volume (cc) was 36.9 (range: 7.02-94.1), 31.5 (range: 6.53-69.7), and 25.15 (range: 6.01-52.5) at pre-SSRS, first, and final follow-up, respectively. Overall volume reduction was seen in the last follow-up in all 14 patients, median 29.01% (range: 6.58%-71.58%). Bilsky score was stable or improved in all patients at the last follow-up when compared with pre-SSRS score. Patients who underwent both surgical decompression and SSRS (n = 9): 8 had improved myelopathic symptoms and pain and 1 had stable radiculopathy postintervention. In the 5 patients treated with SSRS monotherapy, 2 had stable radicular pain and the other 3 improved pain and numbness. No patients experienced adverse outcomes. CONCLUSION To our knowledge, this represents the largest series of SVHEE patients treated with SSRS, either as monotherapy or part of a multimodal/separation surgery treatment approach. We demonstrate that SSRS represents a potentially safe and effective treatment option in these patients. However, larger prospective studies and longer follow-ups are necessary to further assess the role, durability, and toxicity of SSRS in the management of these patients.
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Affiliation(s)
- Arpan A Patel
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Lilly
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samuel T Chao
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Edward Benzel
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gandhivarma Subramaniam
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ajit Krishnaney
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - John H Suh
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lilyana Angelov
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, USA
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Murugan P, Manickam R, Rajamanickam T, Muthu S, Dinesan C, Murali A, Appunu K. Evaluation of improvements in plan quality with Photon Optimizer v16.1 for single brain lesion SRS treatment. Rep Pract Oncol Radiother 2024; 28:801-808. [PMID: 38515825 PMCID: PMC10954267 DOI: 10.5603/rpor.98742] [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: 11/22/2022] [Accepted: 12/29/2023] [Indexed: 03/23/2024] Open
Abstract
Background The purpose of this study is to compare the performance of the Photon Optimizer (PO) version 16.1 algorithm with its earlier version PO v13.6 and with Progressive Resolution Optimizer (PRO) version 13.6 algorithms. Materials and methods 20 patients with single brain lesions treated with the stereotactic radiosurgery (SRS) technique were retrospectively selected for this study. Initially, for all patients volumetric modulated arc therapy (VMAT) SRS plans were generated with the PRO v 13.6 algorithm. Then, all the plans were re-generated with two versions 13.6 and 16.1 of PO algorithm using the same setup and dose-volume optimization objectives as that of PRO with a similar planning approach. The quality of the generated plans was analysed using ICRU 91 plan evaluation parameters and also using dice similarity co-efficient (DSC), centre of mass distance (CMD) between target and prescription isodose line, Monitor units (MU) and brain-gross tumor volume (GTV) 12 Gy volume. Paired Student t-test was used for statistical analysis with 0.05 as a significant value. Results PO v16.1 improved all the dosimetric parameters studied compared to PO 13.6, the difference is statistically significant for all the parameters (p < 0.05), except for median dose and brain-GTV 12 Gy volume. PO v16.1 also showed statistically significant improvement for all the dosimetric parameters evaluated, except DSC and conformity index (CI), compared to PRO v13.6. Conclusion The PO v16.1 generated plans are dosimetrically superior to PO v13.6 and PRO v13.6 in terms of target dose coverage and dose gradient with lesser beam modulation and plan complexity for single brain lesion SRS.
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Affiliation(s)
- Perumal Murugan
- Radiation Oncology Department, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - Ravikumar Manickam
- Radiation Oncology Department, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - Tamilarasan Rajamanickam
- Radiation Oncology Department, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - Sivakumar Muthu
- Radiation Oncology Department, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - C Dinesan
- Radiation Oncology Department, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - Abishake Murali
- Radiation Oncology Department, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - Karthik Appunu
- Radiation Oncology Department, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
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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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Vetrano IG, Gioppo A, Faragò G, Pinzi V, Pollo B, Broggi M, Schiariti M, Ferroli P, Acerbi F. Hemangioblastomas and Other Vascular Origating Tumors of Brain or Spinal Cord. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:377-403. [PMID: 37452946 DOI: 10.1007/978-3-031-23705-8_14] [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: 07/18/2023]
Abstract
Hemangioblastomas (HBs) are highly vascularized, slow-growing, rare benign tumors (WHO grade I). They account for about 2% of intracranial neoplasms; however, they are the most common primary cerebellar tumors in adults. Another frequent seat is the spinal cord (2-10% of primary spinal cord tumors). HBs are constituted by stromal and capillary vascular cells; macroscopically, HBs appear as nodular tumors, with or without cystic components. Although most of the HBs are sporadic (57-75%), they represent a particular component of von Hippel-Lindau disease (VHL), an autosomal dominant syndrome with high penetrance, due to a germline pathogenic mutation in the VHL gene, which is a tumor suppressor with chromosomal location on the short arm of chromosome three. VHL disease determines a variety of malignant and benign tumors, most frequently HBs, renal cell carcinomas, pheochromocytomas/paragangliomas, pancreatic neuroendocrine tumors, and endolymphatic sac tumors. Up to 20% of cases are due to de novo pathogenic variants without a family history. Many epidemiologic details of these tumors, especially the sporadic forms, are not well known. The median age of patients with sporadic HBS is about 40 years. More than two-third of VHL patients develop one or more central nervous system HBs during their lifetime; in case of VHL, patients at first diagnosis are usually younger than the patients with sporadic tumors. The most common presenting signs and symptoms are related to increased intracranial pressure, cerebellar signs, or spinal cord alterations in case of spinal involvement. Magnetic resonance imaging is the gold standard for the diagnosis, assessment, and follow-up of HBs, both sporadic and syndrome-related; angiography is rarely performed because the diagnosis is easily obtained with magnetic resonance. However, the diagnosis of an asymptomatic lesion does not automatically result in therapeutic actions, as the risks of treatment and the onset of possible neurological deficit need to be balanced, considering that HBs may remain asymptomatic and have a static or slow-growing behavior. In such cases, regular follow-up can represent a valid therapeutic option until the patients remain asymptomatic. There are no actual pharmacological therapies that are demonstrated to be effective for HBs. Surgery represents the primary therapeutic approach for these tumors. Observation or radiotherapy also plays a role in the long-term management of patients harboring HBs, especially in VHL; in few selected cases, endovascular treatment has been suggested before surgical removal. This chapter presents a systematic overview of epidemiology, clinical appearance, histopathological and neuroradiological characteristics of central nervous system HBs. Moreover, the genetic and molecular biology of sporadic and VHL HBS deserves special attention. Furthermore, we will describe all the available therapeutic options, along with the follow-up management. Finally, we will briefly report other vascular originating tumors as hemangioendotheliomas, hemangiomas, or angiosarcomas.
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Affiliation(s)
- Ignazio G Vetrano
- Neurovascular Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Gioppo
- Interventional Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Faragò
- Interventional Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Valentina Pinzi
- Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Neurovascular Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Schiariti
- Neurovascular Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Neurovascular Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Neurovascular Surgery Unit and Experimental Microsurgical Laboratory, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via G. Celoria 11, 20133, Milan, Italy.
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Miszczyk M, Napieralska A, Woźniak G, Kraszkiewicz M, Gola M, Kalemba M, Głowacki G, Tomasik B, Kocot-Kępska M, Miszczyk L. Conventionally fractionated radiotherapy versus CyberKnife hypofractionated radiotherapy for painful vertebral haemangiomas - A randomized clinical trial. Radiother Oncol 2022; 176:46-52. [PMID: 36184997 DOI: 10.1016/j.radonc.2022.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE The outcomes of conventional radiotherapy for painful vertebral haemangiomas have been improved through dose escalation at the expense of overall treatment time. We hypothesized that with the aid of precise hypofractionated radiotherapy, it is possible to safely deliver a similar biological equivalent dose over a significantly shorter course of treatment with a comparable efficacy and safety. MATERIALS AND METHODS In this prospective, single-institution unblinded randomized clinical trial (NCT02332408) patients with painful vertebral haemangiomas were allocated one-to-one either to 25 Gy delivered in five fractions (CK) or conventionally fractionated radiotherapy up to 36 Gy (conv.). The main endpoint was pain relief at two years, measured on a subjective and numerical scale (NRS). RESULTS The trial was finished yielding 74 evaluable patients, including 38 in the CK arm. Adverse events were infrequent and the treatment was well tolerated. The overall treatment time was significantly shorter in the CK arm (median of 13 days vs 25 days). At two years, more than half of the patients reported improvement (46; 62.2 %) , in 21 cases the pain symptoms were stable (28.4 %), and in seven cases worse (9.5 %). There were significantly more patients reporting improvement in the CK arm (73.7 % vs 50 %; p = 0.036). The median decrease in NRS was 4 (IQR 1-5) or 59 % (IQR 20-86 %), and the difference between arms was not statistically significant. CONCLUSION Five fractions hypofractionated radiotherapy for painful vertebral haemangiomas up to a total dose of 25 Gy is a safe treatment modality, significantly shorter compared to conventional fractionation, and possibly more effective.
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Affiliation(s)
- Marcin Miszczyk
- III(rd) Radiotherapy and Chemotherapy Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland.
| | - Aleksandra Napieralska
- Radiotherapy Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Grzegorz Woźniak
- Radiotherapy Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Małgorzata Kraszkiewicz
- Radiotherapy Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Michał Gola
- Radiology and Diagnostic Imaging Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Michał Kalemba
- Department of Nuclear Medicine and Endocrine Oncology, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Grzegorz Głowacki
- Radiotherapy Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Bartłomiej Tomasik
- Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Magdalena Kocot-Kępska
- Department of Pain Research and Treatment, Jagiellonian University Medical College, Krakow, Poland
| | - Leszek Miszczyk
- III(rd) Radiotherapy and Chemotherapy Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
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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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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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Uysal B, Gamsiz H, Dincoglan F, Sager O, Demiral S, Dirican B, Beyzadeoglu M. Single-center outcomes of image-guided radiotherapy in the management of vertebral hemangioma with daily kilovoltage cone-beam computerized tomography. J Cancer Res Ther 2021; 17:1521-1524. [PMID: 34916388 DOI: 10.4103/jcrt.jcrt_133_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Vertebral hemangiomas are defined as benign proliferation of blood vessels. Vertebral hemangiomas are generally found incidentally by computerized tomography or magnetic resonance imaging; however, they may also cause pain and quality-of-life impairment in some circumstances with reference to their location and association with the spinal cord. In this study, we assessed the utility of image-guided radiation therapy (IGRT) in the management of patients with painful vertebral hemangioma. Materials and Methods Patients receiving IGRT for the management of painful vertebral hemangioma were evaluated. The total dose was 24 Gy delivered in 12 daily fractions. The verbal numeric scale (VNS) was used for the assessment of pain relief. The median follow-up duration was 13 months (range: 6-24 months). Results Median preradiotherapy VNS score was 8 (range: 6-10) and median postradiotherapy VNS score was 1 (range: 0-2) for the total 135 patients treated with IGRT at our department for painful vertebral hemangioma. Reduction in VNS scores after IGRT was statistically significant (P < 0.05). Conclusion Our single-center study revealed that IGRT resulted in substantial relief of pain from vertebral hemangioma. Randomized prospective multicenter trials are needed to shed light on the optimal management of patients suffering from pain due to vertebral hemangioma.
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Affiliation(s)
- Bora Uysal
- Department of Radiation Oncology, Gulhane Training and Research Hospital, University of Health Sciences, Kecioren, Ankara, Turkey
| | - Hakan Gamsiz
- Department of Radiation Oncology, Gulhane Training and Research Hospital, University of Health Sciences, Kecioren, Ankara, Turkey
| | - Ferrat Dincoglan
- Department of Radiation Oncology, Gulhane Training and Research Hospital, University of Health Sciences, Kecioren, Ankara, Turkey
| | - Omer Sager
- Department of Radiation Oncology, Gulhane Training and Research Hospital, University of Health Sciences, Kecioren, Ankara, Turkey
| | - Selcuk Demiral
- Department of Radiation Oncology, Gulhane Training and Research Hospital, University of Health Sciences, Kecioren, Ankara, Turkey
| | - Bahar Dirican
- Department of Radiation Oncology, Gulhane Training and Research Hospital, University of Health Sciences, Kecioren, Ankara, Turkey
| | - Murat Beyzadeoglu
- Department of Radiation Oncology, Gulhane Training and Research Hospital, University of Health Sciences, Kecioren, Ankara, Turkey
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Early response assessment after CyberKnife stereotactic radiosurgery for symptomatic vertebral hemangioma by quantitative parameters from dynamic contrast-enhanced MRI. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2867-2873. [PMID: 33646419 DOI: 10.1007/s00586-021-06742-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 11/28/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The present study aimed to explore the value of DCE-MRI to evaluate the early efficacy of CyberKnife stereotactic radiosurgery in patients with symptomatic vertebral hemangioma (SVH). METHODS A retrospective analysis of patients with spinal SVH who underwent CyberKnife stereotactic radiosurgery from January 2017 to August 2019 was performed. All patients underwent DCE-MRI before treatment and three months after treatment. The parameters included volume transfer constant (Ktrans), transfer rate constant (Kep), and extravascular extracellular space volume fraction (Ve). RESULTS A total of 11 patients (11 lesions) were included. After treatment, six patients (54.5%) had a partial response, five patients (45.4%) had stable disease, and three patients (27.3%) presented with reossification. Ktrans and Kep decreased significantly in the third month after treatment (p = 0.003 and p = 0.026, respectively). ΔKtrans was -46.23% (range, -87.37 to -23.78%), and ΔKep was -36.18% (range, -85.62 to 94.40%). The change in Ve was not statistically significant (p = 0.213), and ΔVe was -28.01% (range, -58.24 to 54.76%). CONCLUSION DCE-MRI parameters Ktrans and Kep change significantly after CyberKnife stereotactic radiosurgery for SVH. Thus, DCE-MRI may be of value in determining the early efficacy of CyberKnife stereotactic radiosurgery.
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Patel S, Ansari D, Patil SN, Burch TG, Chaker AN, Rosinski CL, Chaudhry NS, Mehta AI. High-Grade Spinal Hemangioma: A National Cancer Database Analysis. World Neurosurg 2021; 148:e527-e535. [PMID: 33460817 DOI: 10.1016/j.wneu.2021.01.020] [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: 10/23/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Spinal hemangiomas are common primary tumors of the vertebrae. Although these tumors are most frequently benign and asymptomatic, they can rarely exhibit aggressive growth and invasion into neighboring structures. Treatment for these aggressive variants is controversial, often involving surgery, chemotherapy, and/or radiotherapy. This study sought to investigate current trends affecting overall survival (OS) using the National Cancer Database (NCDB) and to formulate treatment recommendations. METHODS The National Cancer Database was queried for spinal hemangiomas between 2004 and 2016. A Cox proportional hazards model was used to perform multivariate regression analysis of survival. Survival curves for comparative visualization of demographic and treatment factors were generated using a semiparametric Cox approach. RESULTS A cohort of 102 patients with histologically confirmed spinal hemangiomas was identified in the database. Mean OS was 1.94 years. Administered treatments included partial surgical resection (n = 17), radical resection (n = 14), chemotherapy (n = 34), and radiotherapy (n = 56). Multivariate analysis revealed associations between decreased OS and advanced age (>65 years) and presence of metastasis. Cox survival analysis further revealed improved OS in patients who received surgical treatment and higher radiation dose. CONCLUSIONS This retrospective analysis finding that treatment with surgical resection and/or radiotherapy is associated with increased OS constitutes the largest cohort of patients with aggressive vertebral hemangiomas to date. Given that the mean OS of the study cohort was 1.94 years, our findings suggest that the optimal treatment regimen to maximize survival should consist of early surgical resection with adjuvant high-dose radiotherapy.
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Affiliation(s)
- Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Darius Ansari
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Shashank N Patil
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Taylor G Burch
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Anisse N Chaker
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Clayton L Rosinski
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Nauman S Chaudhry
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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12
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Yu NY, Sio TT, Lyons MK, Vora SA, Turkmani A, Brown PD, Park SS, Leenstra JL, Bendok BR, Schild SE, Ashman JB. Linear accelerator-based single-fraction stereotactic body radiotherapy for symptomatic vertebral body hemangiomas: The Mayo Clinic experience. J Clin Neurosci 2020; 80:74-78. [PMID: 33099371 DOI: 10.1016/j.jocn.2020.07.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/09/2020] [Accepted: 07/23/2020] [Indexed: 11/27/2022]
Abstract
Symptomatic vertebral hemangiomas (SVHs) are rare benign tumors that when symptomatic require procedural intervention or radiotherapy (RT). Although conventionally-fractionated RT has been an alternative to surgical resection, there is very little data on stereotactic body radiotherapy (SBRT) for SVHs. Six consecutively treated patients with SVHs underwent definitive single-fraction SBRT from 2010 to 2018 at our institution. The RT planning parameters, treatment, outcome, and toxicities are reported for 6 patients with 6 total SVHs treated with single-fraction SBRT. Each patient presented with back pain and received single-fraction SBRT to a thoracic vertebral body hemangioma. One patient had received radiofrequency ablation prior to SBRT. The median SBRT dose was 18 Gy (range, 13-20). Following SBRT, 4 (67%) patients reported improvement in presenting symptoms and 2 patients (33%) were refractory. There were no acute or chronic toxicities associated with SBRT including esophagitis, vertebral compression fractures, or myelopathy. To date, this is the largest series of single-fraction SBRT for SVHs. Single fraction SBRT appears to be a feasible option for SVHs. Further studies are needed to confirm our preliminary findings and optimize dose fractionation.
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Affiliation(s)
- Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Mark K Lyons
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Sujay A Vora
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Ali Turkmani
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - James L Leenstra
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
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13
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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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14
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Kasch R, Scheele J, Hancock M, Hofer A, Maher C, Bülow R, Lange J, Lahm A, Napp M, Wassilew G, Schmidt CO. Prevalence of benign osseous lesions of the spine and association with spinal pain in the general population in whole body MRI. PLoS One 2019; 14:e0219846. [PMID: 31498790 PMCID: PMC6733514 DOI: 10.1371/journal.pone.0219846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/03/2019] [Indexed: 01/16/2023] Open
Abstract
Background Benign osseous lesions of the spine are common but precise population prevalence estimates are lacking. Our study aimed to provide the first population-based prevalence estimates and examine association with back and neck pain. Materials and methods We used data from the population-based Study of Health in Pomerania (SHIP). Whole-body MRI examinations (1.5 Tesla: T1, T2, and TIRM weightings) were available from 3,259 participants. Readings of the spinal MRI images were conducted according to a standardized protocol by a single reader (JS). The intra-rater reliability was greater than Kappa values of 0.98. Pain measures included the seven-day prevalence of spine pain and neck pain, and average spine pain intensity due to spine pain during the past three months. Results We found 1,200 (36.8%) participants with at least one osseous lesion (2,080 lesions in total). Osseous lesions were less common in men than in women (35.5% vs 38.9%; P = .06). The prevalence of osseous lesions was highest at L2 in both sexes. The prevalence of osseous lesions increased with age. Up to eight osseous lesions were observed in a single subject. Hemangioma (28%), and lipoma (13%) occurred most often. Sclerosis (1.7%), aneurysmal bone cysts (0.7%), and blastoma (0.3%) were rare. Different osseous lesions occurred more often in combination with each other. The association with back or neck pain was mostly negligible. Conclusion Osseous lesions are common in the general population but of no clinical relevance for spinal pain. The prevalence of osseous lesions varied strongly across different regions of the spine and was also associated with age and gender. Our population-based data offer new insights and assist in judging the relevance of osseous lesions observed on MRIs of patients.
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Affiliation(s)
- Richard Kasch
- Center for Orthopedics, Trauma Surgery and Rehabilitation Medicine; Clinic and Outpatient Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
- * E-mail:
| | - Josephin Scheele
- Center for Orthopedics, Trauma Surgery and Rehabilitation Medicine; Clinic and Outpatient Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Mark Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, North Ryde, Sydney, Australia
| | - André Hofer
- Center for Orthopedics, Trauma Surgery and Rehabilitation Medicine; Clinic and Outpatient Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Christopher Maher
- The University of Sydney, Sydney School of Public Health, NSW, Sydney, Australia
| | - Robin Bülow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Jörn Lange
- Center for Orthopedics, Trauma Surgery and Rehabilitation Medicine; Department of Trauma Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Andreas Lahm
- Center for Orthopedics, Trauma Surgery and Rehabilitation Medicine; Clinic and Outpatient Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
- Kliniken Maria Hilf Mönchengladbach, Academic Teaching Hospital of the RWTH Aachen, Mönchengladbach, Germany
| | - Matthias Napp
- Center for Orthopedics, Trauma Surgery and Rehabilitation Medicine; Department of Trauma Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Georgi Wassilew
- Center for Orthopedics, Trauma Surgery and Rehabilitation Medicine; Clinic and Outpatient Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Carsten Oliver Schmidt
- Institute for Community Medicine, Ernst-Moritz-Arndt University of Greifswald, Greifswald, Germany
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15
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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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16
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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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17
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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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18
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Persad AR, Fox RJ, Rempel JL. Symptomatic Vertebral Hemangioma of the Posterior Elements Sharing Blood Supply with a Radiculomedullary Artery. Int J Spine Surg 2018; 12:415-418. [PMID: 30276100 DOI: 10.14444/5049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Vertebral hemangiomas are common lesions usually restricted to the vertebral body. They are characterized by proliferation of endothelial cells and subsequent expansion of vascular spaces within the bone. These lesions are usually clinically silent and are discovered incidentally. Only rarely are vertebral hemangiomas symptomatic. Here, we present the case of a 68-year-old female with an aggressive hemangioma causing neurologic deficit. The lesion was localized within the posterior spinal elements, with no involvement of the vertebral body. Transarterial embolization was deemed unsafe due to the close proximity of a prominent radiculomedullary artery. The patient was treated with posterior decompression at T4-T6.
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Affiliation(s)
- Amit R Persad
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Richard J Fox
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jeremy L Rempel
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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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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