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Zhao D, Ma Y, Yu X, Bi L, Yue X. Spinal epidural cavernous hemangiomas in the lumbar spine: A case report. Int J Surg Case Rep 2024; 114:109040. [PMID: 38029575 PMCID: PMC10698515 DOI: 10.1016/j.ijscr.2023.109040] [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: 10/07/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Spinal epidural cavernous hemangiomas (SECHs) are relatively rare intradural epidural lesions of the spinal canal, and those occurring in the lumbar spine are even rarer. CASE PRESENTATION A 60-year-old man presented for low back pain with right leg pain. His pee and feces were both normal but symptoms were very similar to a typical lumbar disc herniation. The MRI findings suggest an epidural space of unknown nature in the spinal cord at the L2-3 level and a definite diagnosis of SECHs was made by postoperative pathological examination. CLINICAL DISCUSSION Patients who are suspected of having SECHs should undergo initial classification and differential diagnosis based on MRI imaging features. It is crucial to identify the responsible segment in correlation with the presenting symptoms. During surgery, the primary objective should be the complete removal of the mass, while taking utmost care to protect the nerves. Dynamic stabilization systems, utilizing pedicle rods, can be considered as one of the treatment options for such patients. CONCLUSION Patients presenting with low back pain and neurological symptoms should undergo MRI, and diagnosed with SECHs should undergo early surgical intervention. For patients with an intradural mass in the spinal canal, complete resection should be performed while prioritizing nerve protection.
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Affiliation(s)
- Dingyan Zhao
- Dongzhimen Hospital Afliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Yukun Ma
- Dongzhimen Hospital Afliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Xing Yu
- Dongzhimen Hospital Afliated to Beijing University of Chinese Medicine, Beijing 100700, China.
| | - Lianyong Bi
- Dongzhimen Hospital Afliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Xinliang Yue
- Dongzhimen Hospital Afliated to Beijing University of Chinese Medicine, Beijing 100700, China
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2
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Safar O, Al-Qahtani A, Al-Qahtani S. Urinary Bladder Hemangioma Successfully Treated by Angioembolization with Long-Term Follow-Up: Case Report and Literature Review. Diagnostics (Basel) 2023; 13:diagnostics13050875. [PMID: 36900025 PMCID: PMC10001091 DOI: 10.3390/diagnostics13050875] [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: 01/22/2023] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
Hemangiomas are benign blood vessel and capillary tumor growths which are widespread in many organs but extremely rare in the bladder, making up just 0.6% of all bladder tumors. To the best of our knowledge, few cases of bladder hemangioma are associated with pregnancy in the literature, and no bladder hemangiomas have been discovered incidentally after abortion. The use of angioembolization is well established; however, postoperative follow-up is crucial to identify tumor recurrence or residual disease. Case presentation: In 2013, a 38-year-old female was referred to a urology clinic with an incidental finding after an abortion of a large bladder mass identified incidentally using ultrasound (US). The patient was recommended for CT, which reported a polypoidal hypervascular lesion, as previously described arising from the urinary bladder wall. Diagnostic cystoscopy showed a large, bluish-red, pulsatile, vascularized submucosal mass with large dilated submucosal vessels, a wide-based stalk, and no active bleeding in the posterior wall of the urinary bladder, measuring about 2 × 3 cm, with negative urine cytology. Due to the vascular nature of the lesion and no active bleeding, the decision was made not to biopsy. The patient underwent angioembolization and scheduled for US every six months with regular diagnostic cystoscopy. In 2018, at 5 years of follow-up, the patient developed recurrence after a successful pregnancy. The angiography revealed recanalization of the previously embolized left superior vesical arteries from the anterior division of the left internal iliac artery, resulting in arteriovenous malformation (AVM). The second angioembolization was performed, with the total exclusion of AVM without residual. By the end of 2022, the patient had remained asymptomatic and without recurrence. Conclusion: Angioembolization is a safe treatment technique, minimally invasive, and has less effect on the quality of life, especially in young patients. Long-term follow-up is essential for detecting tumor recurrence or residual disease.
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Affiliation(s)
- Omar Safar
- Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte P.O. Box 101, Saudi Arabia
- Correspondence:
| | - Abdulhadi Al-Qahtani
- Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte P.O. Box 101, Saudi Arabia
| | - Saad Al-Qahtani
- Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte P.O. Box 101, Saudi Arabia
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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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Choudhary D, Mohan V, Varsha AS, Hegde A, Menon G. Neurosurgical emergencies during pregnancy - Management dilemmas. Surg Neurol Int 2023; 14:151. [PMID: 37151438 PMCID: PMC10159311 DOI: 10.25259/sni_1076_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Abstract
Background Neurosurgical emergencies in the obstetric setting pose considerable challenges. Decision-making involves deliberations on the gestational age, critical nature of the illness, timing of surgery, maternal positioning during neurosurgery, anesthesiologic strategies, monitoring of the pregnancy during surgery, and the mode of delivery. The present study discusses the management and ethical dilemmas encountered during the management of six obstetric patients with neurosurgical emergencies. Methods A retrospective review of all neurosurgical operations performed between January 2016 and December 2022 were included in the study. Results This study includes a series of six pregnant women who presented with neurosurgical emergencies, secondary to freshly diagnosed pathologies in the period 2016-2022. The mean maternal age was 31.33 years. Four of the six patients were in the third semester and two were in the second trimester. The underlying etiologies were as follows: spontaneous intracerebral hypertensive hemorrhage (1), obstructive hydrocephalus due to shunt malfunction (1), brain tumor (02), and compressive spinal cord myelopathy due to tumors (02). Three patients who were near term underwent lower cesarean section followed by emergency neurosurgical procedure in the same sitting. Two second trimester patients continued their pregnancy after the emergency neurosurgical operation. In one patient, in whom a brain tumor was diagnosed near term, underwent neurosurgery 1 week after successful cesarean section. All the six mothers and fetus recovered well, ex3cept two patients who have persisting residual deficits. Conclusion Treatment of neurosurgical emergencies during pregnancy needs to be customized depending on the clinical condition of the pregnant woman, prognosis of the disease, gestational age and the status of the pregnancy. With careful planning, timely intervention, consultative decision making and it is possible to achieve the ultimate goal - which is to protect and safeguard the mother and preserve and deliver a viable fetus.
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Affiliation(s)
| | | | | | | | - Girish Menon
- Corresponding author: Girish Menon, Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India.
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Raj A, Abraham A, Raja Navaneethan P, Mathew V. Spinal haemangioma with cauda equina syndrome in pregnancy. BMJ Case Rep 2022; 15:e250306. [PMID: 35760508 PMCID: PMC9237868 DOI: 10.1136/bcr-2022-250306] [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] [Indexed: 11/03/2022] Open
Abstract
The true incidence of haemangiomas, which are the most common benign tumours in the spine, is not known as they are most often asymptomatic and are detected at autopsy. It can become symptomatic due to the haemodynamic and hormonal changes in pregnancy which cause sudden expansion of the lesion. In this paper, we present a case of a woman in her 30s, primigravida at 31 weeks' gestation with acute urinary retention and neurological features suggestive of cauda equina syndrome. Imaging confirmed the diagnosis of vertebral haemangioma involving T12 vertebra encroaching the posterior dural space and abutting the cord. She underwent surgical excision of the haemangioma with complete recovery of neurological symptoms on postoperative follow-up.
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Affiliation(s)
- Arathy Raj
- Department of Obstetrics and Gynecology, Unit III, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Anuja Abraham
- Department of Obstetrics and Gynecology, Unit III, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Preethi Raja Navaneethan
- Department of Obstetrics and Gynecology, Unit III, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Vivek Mathew
- Department of Neurosciences, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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Ridzoňová L, Fedičová M, Andráš T, Urdzík P, Gdovinová Z. Lower-limb progressive paraparesis management and diagnosis overview in a pregnant woman with vertebral haemangioma. WOMEN'S HEALTH 2022; 18:17455057221099018. [PMID: 35574823 PMCID: PMC9109165 DOI: 10.1177/17455057221099018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vertebral haemangioma is a benign vascular tumour mostly seen in the thoracic region of the spine. Spinal haemangiomas are usually asymptomatic and are discovered incidentally. In a few patients, however, aggressive vertebral haemangiomas can cause local pain, radicular pain or neurologic deficits, which result from neural compression. The aetiology of the origin is unclear and is probably multifactorial. Hormonal and biological changes in pregnant women can lead to accelerated vascular growth of haemangioma. In our report, we present the case of a pregnant patient who was diagnosed with an aggressive vertebral haemangioma that further led to progressive paraparesis. We had to take the fact that she was pregnant into account in the diagnostic procedure, in the choice of examination method and also in the method of therapy. The goal of this case report is threefold: (1) provide an overview of the possible methods of management, specifically imaging, which will aid in diagnosis and based on that, (2) determining the appropriate therapy and (3) review the risks and benefits of each will be presented when choosing individual approaches.
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Affiliation(s)
- Lívia Ridzoňová
- Department of Neurology, Louis Pasteur University Hospital, Kosice, Slovakia
| | - Miriam Fedičová
- Department of Neurology, Louis Pasteur University Hospital, Kosice, Slovakia
| | - Tomaš Andráš
- Department of Neurosurgery, Louis Pasteur University Hospital, Kosice, Slovakia
| | - Peter Urdzík
- Department of Gynaecology and Obstetrics, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovakia
| | - Zuzana Gdovinová
- Department of Neurology, Louis Pasteur University Hospital, Kosice, Slovakia
- Department of Neurology, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovakia
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7
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Marchesini N, Ricci UM, Pinna G. Sporadic cauda equina hemangioblastoma: surgical management in a pregnant woman. Br J Neurosurg 2021; 37:1-5. [PMID: 33877021 DOI: 10.1080/02688697.2021.1914820] [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: 01/18/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
Hemangioblastoma is a rare benign vascular tumour of the central nervous system that occurs either sporadically or in association with Von Hippel-Lindau syndrome. Hemangioblastoma can be found throughout the central nervous system and usually present with late manifestations due to their slow growth rate. Cauda equina hemangioblastomas are extremely rare, and in the literature, no cases are reported on the surgical management of pregnant patients with this condition. We report the case of a young woman with back pain and sphincter dysfunctions in whom an L1-L2 hemangioblastoma was diagnosed. We describe the perioperative and surgical strategies we adopted to successfully treat the patient and preserve the fetus well-being.
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Affiliation(s)
- Nicolò Marchesini
- Department of Neurosurgery, Borgo Trento Hospital, University of Verona, Verona, Italy
| | - Umberto Maria Ricci
- Department of Neurosurgery, Borgo Trento Hospital, AOUI Verona, Verona, Italy
| | - Giampietro Pinna
- Department of Neurosurgery, Borgo Trento Hospital, AOUI Verona, Verona, Italy
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Prabhu RM, Rathod TN. Recurrent symptomatic vertebral hemangioma in pregnancy managed with decompression and vertebroplasty. Surg Neurol Int 2021; 12:150. [PMID: 33948320 PMCID: PMC8088490 DOI: 10.25259/sni_34_2021] [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: 01/14/2021] [Accepted: 03/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Vertebral hemangioma is a benign vascular tumor of the spine that occurs in the endothelial lining of blood vessels. The majority of these lesions are detected incidentally on routine magnetic resonance imaging scans. Rarely, lesions can increase in size and result in neurological deterioration. Case Description: A 19-year-old post-partum female, presented with paraplegia due to a recurrent vertebral hemangioma with exophytic extension into the epidural space resulting in spinal cord compression. Early decompressive surgery facilitated adequate early recovery of neurological function. Conclusion: Exophytic vertebral hemangiomas that have extended into the spinal canal resulting in cord compression require urgent surgical decompression.
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Affiliation(s)
- Rudra Mangesh Prabhu
- Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Tushar N Rathod
- Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
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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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Zhao L, Jiang Y, Wang Y, Bai Y, Sun Y, Li Y. Spinal Epidural Cavernous Hemangiomas: A Clinical Series of 9 Cases and Literature Review. Front Oncol 2021; 11:572313. [PMID: 33816222 PMCID: PMC8010302 DOI: 10.3389/fonc.2021.572313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Spinal epidural cavernous hemangiomas are very rare vascular lesions and are, therefore, seldom reported and easily misdiagnosed. Herein, we present a series of 9 cases with spinal epidural cavernous hemangiomas and discuss their pathogenesis, clinical characteristics, radiological findings, differential diagnosis, surgical interventions, pathological characteristics, and prognosis. Methods We retrospectively retrieved and analyzed the data of patients with pure epidural cavernous hemangiomas, who underwent spinal magnetic resonance imaging, and surgical intervention at the First Hospital of Jilin University, China, between January 2005 and December 2019. The data on patients’ clinical manifestations, imaging characteristics, surgical intervention, histopathological findings, and postoperative follow-up were also recorded and analyzed. Results In all, 5 men and 4 women with the mean age of 61 years (range, 41–78 years) were recruited. All patients experienced a gradual onset of symptoms and a slowly progressive clinical course, and no patient presented an acute onset of symptoms. The clinical manifestations include myelopathic signs in 8 patients (88.9%) and radicular symptoms in 3 patients (33.3%). On T1-weighted imaging, 6 lesions appeared isointense (55.6%), and 4 lesions exhibited hypointense (44.4%) signals. On T2-weighted imaging, 8 lesions appeared hyperintense (88.9%), and 1 lesion was heterogeneously intense (11.1%). Following gadolinium administration, 5 lesions appeared homogeneous with significant enhancement (55.6%), 1 lesion was homogeneous and mild enhancement (11.1%), and 3 lesions were heterogeneous with mild enhancement (33.3%). All patients received early microsurgery assisted by intraoperative electrophysiologic monitoring and neuronavigation in the lateral position via the posterior midline approach. Five patients underwent total laminectomy (55.6%), and 4 underwent hemilaminectomy (44.4%). Total excision was achieved in all cases. The average follow-up period was 55.1 months (ranging 10–123 months). All patients exhibited significant clinical improvement of their neurological deficits and achieved a favorable outcome with no recorded recurrence at last follow-up. Conclusions Spinal epidural cavernous hemangiomas are rare vascular malformations. Early surgical treatment with total resection is an optimum treatment, particularly for patients with an acute exacerbation onset. The prognosis is mostly good and depends predominantly on the severity of the preoperative status.
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Affiliation(s)
- Liyan Zhao
- Department of Clinical Laboratory, Second Hospital of Jilin University, Changchun, China
| | - Yining Jiang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yubo Wang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yang Bai
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Ying Sun
- Department of Clinical Laboratory, Second Hospital of Jilin University, Changchun, China
| | - Yunqian Li
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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Bourghli A, Abduljawad SM, BoissiÈre L, Khalifa H, Obeid I. Aggressive Thoracic Hemangioma Leading to Secondary Kyphosis with Paraparesis in the Postpartum Period. A Case Report. Int J Spine Surg 2020; 14:418-425. [PMID: 32699766 DOI: 10.14444/7055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Aggressive vertebral hemangioma is rare, and its management can be very challenging. Methods In this report, we present the case of a 30-year-old female with a normal twin pregnancy. She had been complaining of midthoracic pain after the seventh month of pregnancy with no other symptoms. Normal delivery was done under spinal anesthesia, but the patient's back pain worsened after the delivery, and she left the hospital on Day 4 with the onset of an unsteady gait. She was seen in the spinal clinic on Day 14, referred by her gynecologist, with a paraparetic presentation that was rapidly worsening. Urgent magnetic resonance imaging (MRI) was done and revealed aggressive hemangioma of T6 with kyphosis and significant cord compression. Results The patient was admitted and was operated the following morning. Posterior decompression with fixation from T4 to T8 and kyphosis correction was done. Samples from the vertebrae were sent to the lab for pathology analysis, and the results confirmed the diagnosis of vertebral hemangioma. She could walk on Day 1 with progressive neurological recovery, but distal junctional kyphosis in the form of a "chance fracture" of T8 occurred at 2 months and was treated conservatively. She showed a satisfactory clinical and radiological result at 2 years with no recurrence. Conclusions Literature is sparse on the management of vertebral hemangioma in the context of pregnancy and postpartum, with only case reports, and its presentation as a kyphotic fracture is extremely rare. The current case shows how, in the context of delivery, a benign procedure such as spinal anesthesia should be done with extreme caution, as it may play a role in aggravating an undiagnosed aggressive hemangioma; rapid management after the onset of paraparetic symptoms enables a full neurological recovery, but close monitoring later on with regular MRI is mandatory for detection of any recurrence.
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Affiliation(s)
- Anouar Bourghli
- Orthopaedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Salim M Abduljawad
- Orthopaedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Louis BoissiÈre
- Orthopaedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France
| | - Hani Khalifa
- Obstetrics and Gynecology Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Ibrahim Obeid
- Orthopaedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France
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12
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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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13
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Aggressive vertebral hemangioma, causing severe neurological impairment in the third trimester of pregnancy – case presentation. GINECOLOGIA.RO 2020. [DOI: 10.26416/gine.29.3.2020.4059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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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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Wang GX, Mu YD, Che JY, Zhang GF, Jiang G, Gao CP. Compressive myelopathy and compression fracture of aggressive vertebral hemangioma after parturition: A case report and review of literature. Medicine (Baltimore) 2019; 98:e18285. [PMID: 31852104 PMCID: PMC6922397 DOI: 10.1097/md.0000000000018285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Compressive myelopathy and compression fracture of aggressive vertebral hemangioma after parturition is a rare condition. Vertebral body compression fracture and high serum progesterone lead to extraosseous hemangioma enlargment cause narrowing the spinal canal which contribute to compressive myelopathy relate to pregnancy. PATIENT CONCERNS We report a case of compressive myelopathy and compression fracture of aggressive vertebral hemangioma after parturition in a 35-year-old woman. The patient complained unable to walk and experienced intense pain in the back. DIAGNOSIS Based on the clinical features and imaging studies, the patient underwent a T4-T6 laminectomy. Histopathology consistent with vertebral hemangioma. INTERVENTIONS The patient underwent laminectomy for decompression. After subperiosteal dissection of the paraspinal muscles and exposure of the laminae, there was no involvement of the lamina by the tumor. The epidural tumor was removed through the spaces lateral to the thecal sac. Vertebroplasty was performed through T5 pedicles bilaterally and 7 ml of polymethylmethacrylate (PMMA) cement was injected. T4-T6 pedicle screw fixation was performed for segmental fixation and fusion. OUTCOMES Six months after resection of the tumor the patient remained asymptomatic. She reported no low back pain and had returned to her normal daily activities, with no radiographic evidence of recurrence on MRI. Physical examination revealed that superficial and deep sensation was restored to normal levels in the lower extremities. LESSONS The occurrence of compressive myelopathy of pregnancy related vertebral hemangiomas is quite unusual. It can lead to serious neurologic deficits if not treated immediately. So, prompt diagnosis is important in planning optimal therapy and preventing morbidity for patients.
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Affiliation(s)
- Guan-xi Wang
- Department of Radiology, Songshan Hospital of Qingdao University Medical College University
| | - Yuan-dong Mu
- Department of Radiology, Gaomi people Hospital, Weifang
| | - Jun-yi Che
- Department of Radiology, Qingdao Municipal Hospital
| | | | | | - Chuan-ping Gao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
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16
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Mohanty CR, Jain M, Dash C, Behera SS. Postpartum Paraparesis Due to Aggressive Vertebral Hemangioma Causing Spinal Cord Compression Presenting for Emergency Cesarean Section. J Obstet Gynaecol India 2018; 69:185-187. [PMID: 30956475 DOI: 10.1007/s13224-018-1194-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/17/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Chitta Ranjan Mohanty
- 1Department of Trauma and Emergency, All India Institute of Medical Science, Bhubaneswar, India
| | - Mantu Jain
- 2Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019 India
| | - Chinmaya Dash
- 1Department of Trauma and Emergency, All India Institute of Medical Science, Bhubaneswar, India
| | - Shashi Shankar Behera
- 3Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, 751019 India
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17
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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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Usmani S, Marafi F, Rasheed R, Al Kandari F, Ahmed N. Atypical Hemangioma Mimicking Metastasis on 18F-Sodium Fluoride Positron Emission Tomography-Computed Tomography and Magnetic Resonance Imaging: Gallium-68-Prostate-Specific Membrane Antigen Positron Emission Tomography Improves the Specificity of Bone Lesions. Indian J Nucl Med 2018; 33:171-173. [PMID: 29643687 PMCID: PMC5883444 DOI: 10.4103/ijnm.ijnm_150_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Vertebral hemangioma is a benign condition, but sometimes, it might represent as diagnostic dilemma especially in elderly patient mimicking serious pathology like metastasis. We report a case of a 66-year-old man with prostate cancer. 18F-sodium fluoride positron emission tomography-computed tomography (18F-NaF PET-CT) demonstrates increased radiotracer uptake at body of D4 vertebra. Magnetic resonance imaging shows features of atypical hemangioma; however, metastasis cannot be ruled out. To rule out bone metastasis, gallium-68-prostate-specific membrane antigen PET-CT is performed which shows no abnormal lesion. Eight-month follow-up by 18F-NaF PET-CT showed persistent osteoblastic lesion at D4 without any significant change thus, confirming the initial diagnosis of atypical hemangioma.
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Affiliation(s)
- Sharjeel Usmani
- Department of Nuclear Medicine,Cancer Control Center, Khaitan, Kuwait
| | - Fahad Marafi
- Department of Nuclear Medicine,Cancer Control Center, Khaitan, Kuwait
| | - Rashid Rasheed
- Department of Nuclear Medicine,Cancer Control Center, Khaitan, Kuwait
| | | | - Najeeb Ahmed
- Department of Radiology, Jack Brignall PET/CT Centre, Castle Hill Hosptial, Cottingham, England
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19
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Genital tract cavernous hemangioma as a rare cause of postpartum hemorrhage. Obstet Gynecol Sci 2017; 60:473-476. [PMID: 28989925 PMCID: PMC5621078 DOI: 10.5468/ogs.2017.60.5.473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/29/2017] [Accepted: 06/14/2017] [Indexed: 11/23/2022] Open
Abstract
Cavernous hemangiomas rarely involve the female genital tract. It is difficult to identify vascular malformations when these lesions are concealed in the vagina or deep vulva area. We present a rare case of vaginal cavernous hemangioma in a 30-year-old primiparous woman with an early severe postpartum hemorrhage (PPH) and delayed continuous bleeding from the episiotomy site. She was treated successfully with transarterial embolization of the left vaginal artery. To our knowledge, this is the first reported case of PPH caused by rupture of a vaginal hemangioma during vaginal delivery in English literature.
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20
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Fereydonyan N, Taheri M, Kazemi F. Recurrent symptomatic vertebral hemangioma during two consecutive pregnancies: Case report and review of the literature. Surg Neurol Int 2017; 8:105. [PMID: 28695052 PMCID: PMC5473073 DOI: 10.4103/sni.sni_93_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/09/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Pregnancy-related changes can exacerbate the symptoms/signs of vertebral hemangiomas. Here, we report a patient who experienced symptomatic vertebral hemangiomas resulting in cord compression during two consecutive pregnancies. CASE DESCRIPTION A 28-year-old female 34 weeks pregnant, presented with a progressive spastic paraparesis. Magnetic Resonance Imaging (MRI) demonstrated an T5 vertebral body signal change attributed to a hemangioma resulting in cord compression. Following a cesarean section, she had a trans thoracic T5 corpectomy with spinal fusion. Indeed, the histopathology was consistent with a vertebral hemangioma. She fully recovered after this first surgery. However, six years later, she again presented with a spastic paraparesis and sphincter deficit now 29 weeks pregnant. The MR demonstrated cord compression one more at the T5 level attributed to the hemangioma; following a T5 and T6 laminectomy, the left paracentral epidural vascular mass totally resected. Her child was successfully delivered 2 months later at which point she exhibited only mild residual lower limb spasticity. CONCLUSION Patients with known vertebral hemangiomas should be closely monitored during pregnancy as increased growth during these pregnancies may result in progressive spinal cord compression.
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Affiliation(s)
| | - Morteza Taheri
- Department of Neurosurgery, Rasool Akram Hospital, Tehran, Iran
| | - Farid Kazemi
- Department of Neurosurgery, Rasool Akram Hospital, Tehran, Iran
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21
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Abstract
OBJECTIVE Vertebral hemangiomas are common tumors that are benign and generally asymptomatic. Occasionally these lesions can exhibit aggressive features such as bony expansion and erosion into the epidural space resulting in neurological symptoms. Surgery is often recommended in these cases, especially if symptoms are severe or rapidly progressive. Some surgeons perform decompression alone, others perform gross-total resection, while others perform en bloc resection. Radiation, embolization, vertebroplasty, and ethanol injection have also been used in combination with surgery. Despite the variety of available treatment options, the optimal management strategy is unclear because aggressive vertebral hemangiomas are uncommon lesions, making it difficult to perform large trials. For this reason, the authors chose instead to report their institutional experience along with a comprehensive review of the literature. METHODS A departmental database was searched for patients with a pathological diagnosis of "hemangioma" between 2008 and 2015. Medical records were reviewed to identify patients with aggressive vertebral hemangiomas, and these cases were reviewed in detail. RESULTS Five patients were identified who underwent surgery for treatment of aggressive vertebral hemangiomas during the specified time period. There were 2 lumbar and 3 thoracic lesions. One patient underwent en bloc spondylectomy, 2 patients had piecemeal gross-total resection, and the remaining 2 had subtotal tumor resection. Intraoperative vertebroplasty was used in 3 cases to augment the anterior column or to obliterate residual tumor. Adjuvant radiation was used in 1 case where there was residual tumor as well. The patient who underwent en bloc spondylectomy experienced several postoperative complications requiring additional medical care and reoperation. At an average follow-up of 31 months (range 3-65 months), no patient had any recurrence of disease and all were clinically asymptomatic, except the patient who underwent en bloc resection who continued to have back pain. CONCLUSIONS Gross-total resection or subtotal resection in combination with vertebroplasty or adjuvant radiation therapy to treat residual tumor seems sufficient in the treatment of aggressive vertebral hemangiomas. En bloc resection appears to provide a similar oncological benefit, but it carries higher morbidity to the patient.
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Affiliation(s)
| | - John H Chi
- Brigham and Women's Hospital, Harvard Medical School; and.,Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Michael W Groff
- Brigham and Women's Hospital, Harvard Medical School; and.,Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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22
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Conservative management of maternal cervical vertebral hemangioma complicating pregnancy. Obstet Gynecol 2015; 125:735-738. [PMID: 25730240 DOI: 10.1097/aog.0000000000000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although vertebral hemangiomas are found in 10% of the population, they rarely become symptomatic. We describe management of an enlarging cervical vertebral hemangioma during pregnancy. CASE A primiparous woman at 33 weeks of gestation presented with neck pain and paresthesias. She had a known cervical hemangioma. Imaging revealed a C6-C7 hemangioma with extradural extension. Her symptoms fluctuated, and she was delivered by cesarean at 36 weeks of gestation. Improvement occurred after delivery, and radiographic regression of the hemangioma was demonstrated. CONCLUSION Hormonal and vascular changes of pregnancy may exacerbate spinal hemangiomas. Depending on the location, these may lead to profound neurologic disability and management depends on the degree of myelopathy. Surgical intervention may be necessary to avoid neurologic injury, but amelioration after delivery is possible.
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23
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Slimani O, Jayi S, Fdili Alaoui F, Bouguern H, Chaara H, Fikri G, Alaoui Rachidi S, Sqalli Houssaini N, Himmich M, Abdelilah Melhouf M. An aggressive vertebral hemangioma in pregnancy: a case report. J Med Case Rep 2014; 8:207. [PMID: 24943121 PMCID: PMC4088364 DOI: 10.1186/1752-1947-8-207] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/21/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction Pregnancy-related compressive myelopathy secondary to vertebral hemangioma is a rare occurrence and its treatment antepartum is rare. Case presentation A 19-year-old North African woman in her 38th week of pregnancy presented with paraplegia that progressed within 2 days after a rapidly progressive weakness of her lower limbs. Magnetic resonance imaging studies showed compression of her spinal cord in front of the fourth thoracic vertebra for suspected tuberculous spondylitis. A Caesarean section was done followed by corpectomy with a bone graft because we intraoperatively discovered a vertebral hemangioma. Pathology showed an aggressive hemangioma. Conclusion At any term of pregnancy, extensive neurological involvement which is rapidly progressive due to compression should be considered for immediate decompression.
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Affiliation(s)
- Ouafae Slimani
- Department of Gynecology Obstetric II, Teaching Hospital Hassan II, Fez, Morocco.
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24
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Gupta M, Nayak R, Singh H, Khwaja G, Chowdhury D. Pregnancy related symptomatic vertebral hemangioma. Ann Indian Acad Neurol 2014; 17:120-2. [PMID: 24753678 PMCID: PMC3992751 DOI: 10.4103/0972-2327.128577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/05/2013] [Accepted: 06/06/2013] [Indexed: 11/15/2022] Open
Abstract
Vertebral hemangiomas are benign vascular tumors of the spine that remain asymptomatic in most cases and incidentally encountered on imaging. Rarely, altered hemodynamic and hormonal changes during pregnancy may expand these benign lesions resulting in severe cord compression. The management of symptomatic vertebral hemangioma during pregnancy is controversial as modalities like radiotherapy and embolization are not suitable and surgery during pregnancy has a risk of preterm labor. Few cases of pregnancy related symptomatic vertebral hemangioma with marked epidural component have been reported in the literature. We report a case of 23-year-old primigravida who developed rapidly progressive paraparesis at 28 weeks of gestation and spine magnetic resonance imaging (MRI) revealed upper thoracic vertebral hemangioma with extensive extra-osseous extension and spinal cord compression. Laminectomy and surgical decompression of the cord was performed at 32 weeks of the pregnancy. There was significant improvement in muscle power after a week of surgery. Six weeks postoperatively she delivered a full term normal baby with subsequent improvement of neurologic deficit. Repeat MRI of dorsal spine performed at 3 months postoperatively showed reduced posterior and anterior epidural components of vertebral hemangioma.
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Affiliation(s)
- Meena Gupta
- Department of Neurology, GB Pant Hospital, New Delhi, India
| | - Rajeev Nayak
- Department of Neurology, GB Pant Hospital, New Delhi, India
| | - Hukum Singh
- Department of Neurosurgery, GB Pant Hospital, New Delhi, India
| | - Geeta Khwaja
- Department of Neurology, GB Pant Hospital, New Delhi, India
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25
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Moles A, Hamel O, Perret C, Bord E, Robert R, Buffenoir K. Symptomatic vertebral hemangiomas during pregnancy. J Neurosurg Spine 2014; 20:585-91. [PMID: 24605997 DOI: 10.3171/2014.2.spine13593] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Symptomatic vertebral hemangiomas during pregnancy are rare, as only 27 cases have been reported in the literature since 1948. However, symptomatic vertebral hemangiomas can be responsible for spinal cord compression, in which case they constitute a medical emergency, which raises management difficulties in the context of pregnancy. Pregnancy is a known factor responsible for deterioration of these vascular tumors. In this paper, the authors report 2 clinical cases of symptomatic vertebral hemangiomas during pregnancy, including 1 case of spontaneous fracture that has never been previously reported in the literature. The authors then present a brief review of the literature to discuss emergency management of this condition. The first case was a 28-year-old woman at 35 weeks of gestation, who presented with paraparesis. Spinal cord MRI demonstrated a vertebral hemangioma invading the body and posterior arch of T-3 with posterior epidural extension. Laminectomy and vertebroplasty were performed after cesarean section, allowing neurological recovery. The second case involved a 35-year-old woman who presented with spontaneous fracture of T-7 at 36 weeks of gestation, revealing a vertebral hemangioma with no neurological deficit, but it was responsible for pain and local instability. Treatment consisted of postpartum posterior interbody fusion. With a clinical and radiological follow-up of 2 years, no complications and no modification of the hemangiomas were observed. A review of the literature reveals discordant management of these rare cases, which is why the treatment course must be decided by a multidisciplinary team as a function of fetal gestational age and maternal neurological features.
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Affiliation(s)
- Alexis Moles
- Department of Neurosurgery and Neurotraumatology
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26
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Abstract
Pregnancy creates alterations in maternal physiology which predispose to unique neurologic disorders. Pre-eclampsia, eclampsia, certain types of ischemic and hemorrhagic stroke, reversible cerebral vasoconstriction syndrome, posterior reversible encephalopathy syndrome, and thunderclap headache all appear to share a common origin from vascular endothelial dysfunction, with overlapping clinical presentations. Multiple sclerosis often improves during pregnancy. Compression mononeuropathies may occur in the extremities. Myasthenia gravis may affect second stage labor. Various inflammatory peripheral neuropathies, dystrophies, myopathies may occur during pregnancy. The safety of specific immune suppressants is reviewed. Epilepsy does not have a significant effect upon the course of pregnancy, albeit there is a modest increase in the need for cesarean section. Certain antiepileptic drugs may produce fetal malformations, most notably valproic acid. Brain tumors are rare during pregnancy, but may increase in size due to activation of hormonal receptors on tumor cells surfaces, water retention, and engorged blood vessels.
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Affiliation(s)
- H Steven Block
- Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - José Biller
- Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
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27
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28
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Familial blue rubber bleb nevus syndrome in pregnancy with spinal epidural involvement. Case Rep Obstet Gynecol 2013; 2013:141506. [PMID: 23762681 PMCID: PMC3665244 DOI: 10.1155/2013/141506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 04/19/2013] [Indexed: 12/20/2022] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder characterized by multiple venous malformations (VMs) of the skin, gastrointestinal tract, and other organs. To date, several cases of sporadic BRBNS involving various parts of the pregnant woman's body have been reported; however, BRBNS in pregnancy with spinal epidural involvement has not been reported. Here, we describe the clinical features and management of familial BRBNS in pregnancy. The patient presented with multiple VMs on her head, neck, floor of the mouth, trunk, leg, foot, and vulva and spinal epidural lesions. The patient's mother and sister also exhibited multiple VMs similar lesions, indicating a familial form of BRBNS. Cesarean section under general anesthesia was performed, and a healthy male neonate was delivered. The mother's postoperative course was uneventful and her VMs decreased in size after delivery. Physicians should consider the possibility of systemic diseases and familial inheritance in cases of VMs.
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Yao KC, Malek AM. Transpedicular N-butyl cyanoacrylate–mediated percutaneous embolization of symptomatic vertebral hemangiomas. J Neurosurg Spine 2013; 18:450-5. [DOI: 10.3171/2013.1.spine11173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The resection of spinal hemangiomas is often challenging because of characteristic high-volume and potentially prohibitive intraoperative blood loss. Although transarterial embolization can mitigate this risk, it can be suboptimal when tumor arterial supply is diffuse or poorly defined. The authors present their experience in the use of preoperative percutaneous direct injection of spinal hemangiomas with N-butyl cyanoacrylate (NBCA) as an effective preoperative adjunct that may reduce operative blood loss and facilitate resection of these vascular tumors.
Methods
Four patients with symptomatic spinal hemangiomas were treated using percutaneous transpedicular direct NBCA-Lipiodol injection; 2 patients had undergone prior spinal angiography, with suboptimal transarterial embolization in 1. Each patient underwent percutaneous bilateral transpedicular NBCA-assisted tumor embolization prior to resection. Retrospective analysis of operative times, blood loss, and clinical data is presented.
Results
There were no complications associated with the percutaneous NBCA embolization technique. The procedure was effective at facilitating tumor removal and minimizing intraoperative blood loss, especially at the vertebral body resection stage. Improved tumor filling was achieved as the filling characteristics of dilute NBCA-Lipiodol mixture within large-channel, high-flow hemangiomas were appreciated with experience.
Conclusions
Transpedicular NBCA direct-puncture embolization of spinal hemangiomas is an effective preoperative adjunct that facilitates resection of these highly vascular tumors. It is particularly useful when transarterial embolization is unsafe or suboptimal due to constraints imposed by the local angioarchitecture.
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Affiliation(s)
- Kevin C. Yao
- 1Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York; and
| | - Adel M. Malek
- 2Department of Neurosurgery, Cerebrovascular and Endovascular Division, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
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30
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Omidi-Kashani F, Hasankhani EG, Akhlaghi S, Golhasani-Keshtan F, Toosi KZ. Percutaneous vertebroplasty in symptomatic hemangioma versus osteoporotic compression fracture. Indian J Orthop 2013; 47:234-7. [PMID: 23798752 PMCID: PMC3687898 DOI: 10.4103/0019-5413.111498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Percutaneous vertebroplasty (PVP) is more commonly used for osteoporotic compression fractures (OCFs) and osteolytic vertebral body tumors. This study aimed to study the differences between OCFs and vertebral hemangiomas (VHs) treated with PVP. MATERIALS AND METHODS Between September 2007 and January 2010, we prospectively treated 28 consecutive patients of OCFs (43 recently symptomatic OCFs) and 24 cases of VHs (26 VHs). We used visual analogue scale (VAS) pain and Oswestry Disability Index (ODI) to evaluate the patients. The followup period in group 1 and 2 were 25.1 months (range 12 - 31 months) and 21.3 months (range 14 - 28 months), respectively. Comparison of means was carried out with the Chi Square Tests, t-test, and N Par-Test for multiple comparisons, whenever appropriate. The level of statistical significance was set at P < 0.05. RESULTS Following PVP the VAS score decreased to 4.57 and 4.17 in group 1 and 2, respectively. The ODI scores were 32.5% and 30%, respectively. This decrease in ODI scores lasted throughout the followup period. CONCLUSIONS Although the preoperative scores were significantly different between group 1 and 2, there was no significant difference between two groups following the PVP.
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Affiliation(s)
- Farzad Omidi-Kashani
- Orthopedic Research Center, Orthopedic Department, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran,Address for correspondence: Dr. Farzad Omidi-Kashani, Orthopedic Department, Emam Reza Hospital, Mashhad, Iran. E-mail:
| | - Ebrahim G Hasankhani
- Orthopedic Research Center, Orthopedic Department, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeed Akhlaghi
- Mathematician, Faculty of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farideh Golhasani-Keshtan
- Physiology, Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Katayoun Z Toosi
- Department of English and Film Studies University of Alberta, Canada
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Ropper AE, Cahill KS, Hanna JW, McCarthy EF, Gokaslan ZL, Chi JH. Primary vertebral tumors: a review of epidemiologic, histological, and imaging findings, Part I: benign tumors. Neurosurgery 2012; 69:1171-80. [PMID: 21725252 DOI: 10.1227/neu.0b013e31822b8107] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Primary vertebral tumors, although less common than metastases to the spine, make up a heterogeneous group of neoplasms that can pose diagnostic and treatment challenges. They affect both the adult and the pediatric population and may be benign, locally aggressive, or malignant. An understanding of typical imaging findings will aid in accurate diagnosis and help neurosurgeons appreciate anatomic subtleties that may increase their effective resection. An understanding of the histological similarities and differences between these tumors is imperative for all members of the clinical team caring for these patients. In this first review of 2 parts, we discuss the epidemiological, histological, and imaging features of the most common benign primary vertebral tumors-aneurysmal bone cyst, chondroma and enchondroma, hemangioma, osteoid osteoma, and osteoblastoma-and lesions related to eosinophilic granuloma and fibrous dysplasia. In addition, we discuss the basic management paradigms for each of these diagnoses. In combination with part II of the review, which focuses on locally aggressive and malignant tumors, this article provides a comprehensive review of primary vertebral tumors.
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Affiliation(s)
- Alexander E Ropper
- Department of Neurosurgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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32
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Jankowski R, Nowak S, Zukiel R, Szymaś J, Sokół B. Surgical treatment of symptomatic vertebral haemangiomas. Neurol Neurochir Pol 2011; 45:577-582. [DOI: 10.1016/s0028-3843(14)60125-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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34
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Kurimoto M, Noguchi K, Nagai S, Asahi T, Kuwayama N, Hayashi N, Endo S. Thoracic vertebral cavernous hemangioma in a schizophrenic patient--case report. Neurol Med Chir (Tokyo) 2010; 50:485-7. [PMID: 20587975 DOI: 10.2176/nmc.50.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 55-year-old man presented with gait disturbance, incontinence, and back pain. He had a medical history of schizophrenia for the past 35 years. Computed tomography (CT) and magnetic resonance imaging suggested thoracic vertebral hemangioma. Dynamic CT incidentally detected a hepatic hemangioma. Laminectomy of T3 and T4, resection of the epidural hemangioma, and rigid instrumentation between T1 and T6 using rod and hook systems were performed. Postoperatively, his symptoms completely disappeared and the histological diagnosis was capillary hemangioma. Schizophrenic patients have diminished sensitivity to pain or other symptoms, so neurological symptoms may become severe. However, early and appropriate treatment can result in satisfactory neurological outcome. The patient had a rare association of vertebral hemangioma and hepatic hemangioma, which may be a chance occurrence.
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Saeed G, Fakhar S, Khan I. Vertebral Tumors Mimicking Exaggerated Pregnancy Symptoms—A Need for Careful Evaluation. Taiwan J Obstet Gynecol 2010; 49:228-30. [DOI: 10.1016/s1028-4559(10)60051-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2009] [Indexed: 11/25/2022] Open
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Lousquy R, Morel O, Bisdorff A, Drouet L, Rossignol M, Barranger E. [Pregnancy follow-up and outcome in women with superficial vascular malformations]. ACTA ACUST UNITED AC 2010; 38:350-7. [PMID: 20430676 DOI: 10.1016/j.gyobfe.2009.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 10/31/2009] [Indexed: 11/29/2022]
Abstract
Superficial vascular malformations (MAV), so far called "superficial angioma", are uncommon and often unknown. The last classification, done by the "International Society for the Study of Vascular Anomalies", is essential to avoid diagnostic and therapeutic mistakes. Extramedullar localisations are rare. The coexistence of a pregnancy and a MAV states two problems: the medical and paraclinic supervision of the volume of the MAV and its risk of thrombosis with the choice of thrombosis prevention, and the mode of delivery and type of anaesthesia depending on its anatomical location. We revised the management of pregnant women with a MAV illustrating possible troubles to deal with. We reported the cases of two women having for the first one a pharyngolaryngeal MAV, the second a cutaneous MAV located on the leg and needing a multidisciplinary management with obstetricians, anaesthesists, hematologists, dermatologists, ENT, radiologists and pediatricians.
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Affiliation(s)
- R Lousquy
- Service de gynécologie obstétrique, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
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Lee JH, Park CW, Chung DH, Kim WK. A case of lumbar metastasis of choriocarcinoma masquerading as an extraosseous extension of vertebral hemangioma. J Korean Neurosurg Soc 2010; 47:143-7. [PMID: 20224716 DOI: 10.3340/jkns.2010.47.2.143] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 11/30/2009] [Accepted: 12/27/2009] [Indexed: 12/13/2022] Open
Abstract
We report here on an uncommon case of metastatic choriocarcinoma to the lung, brain and lumbar spine. A 33-year-old woman was admitted to the pulmonary department with headache, dyspnea and hemoptysis. There was a history of cesarean section due to intrauterine fetal death at 37-weeks gestation and this occurred 2 weeks before admission to the pulmonary department. The radiological studies revealed a nodular lung mass with hypervascularity in the left upper lobe and also a brain parenchymal lesion in the parietal lobe with marginal bleeding and surrounding edema. She underwent embolization for the lung lesion, which was suspected to be an arteriovenous malformation according to the pulmonary arteriogram. Approximately 10 days after discharge from the pulmonary department, she was readmitted due to back pain and progressive paraparesis. The neuroradiological studies revealed a hypervascular tumor occupying the entire L3 vertebral body and pedicle, and the tumor extended to the epidural area. She underwent embolization of the hypervascular lesion of the lumbar spine, and after which injection of polymethylmethacrylate in the L3 vertebral body, total laminectomy of L3, subtotal removal of the epidural mass and screw fixation of L2 and L4 were performed. The result of biopsy was a choriocarcinoma.
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Affiliation(s)
- Ji Hoon Lee
- Department of Neurosurgery, Gachon University of Medical & Science, Gil Medical Center, Incheon, Korea
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Lakemeier S, Westhoff CC, Fuchs-Winkelmann S, Schofer MD. Osseous hemangioma of the seventh cervical vertebra with osteoid formation mimicking metastasis: a case report. J Med Case Rep 2009; 3:92. [PMID: 19946508 PMCID: PMC2783091 DOI: 10.1186/1752-1947-3-92] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 11/02/2009] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION We report the case of an osseous hemangioma located in the seventh cervical vertebra with reactive osteoid formation and non-typical findings in the radiological and the histopathological examination, mimicking metastasis of a malignant tumor. To our knowledge, this is the first description of such a case in the literature. CASE PRESENTATION A 44-year-old otherwise healthy Caucasian German woman presented with a discrete sensorimotor loss of both upper limbs. Radiologically, an osteolysis in the seventh cervical vertebra suggestive of metastasis of a malignant neoplasm was diagnosed. After performing corporectomy and cage implantation of C7 on the patient, the histopathological examination was complicated by marked osteoid formation obscuring the true diagnosis of an osseous hemangioma with reactive osteoid formation. CONCLUSION Though hemangioma of the bone is a rare tumorous lesion in the cervical spine, it has to be taken into consideration as a reason for neck pain and sensomotoric loss of the upper limbs. Atypical radiological and histopathological presentations may hinder determination of the correct diagnosis. The treatment of such lesions must follow clinical guidelines but may be difficult to define in some cases when the correct diagnosis is not known at the time when therapy starts.
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Affiliation(s)
- Stefan Lakemeier
- Department of Orthopaedics, University Hospital Giessen and Marburg, Location Marburg, Baldingerstrasse, 35033 Marburg, Germany
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Hayden MG, Gephart R, Kalanithi P, Chou D. Von Hippel-Lindau disease in pregnancy: A brief review. J Clin Neurosci 2009; 16:611-3. [DOI: 10.1016/j.jocn.2008.05.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 05/19/2008] [Accepted: 05/22/2008] [Indexed: 11/29/2022]
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Clinical approach and surgical strategy for spinal diseases in pregnant women: a report of ten cases. Spine (Phila Pa 1976) 2008; 33:E614-9. [PMID: 18670331 DOI: 10.1097/brs.0b013e31817c6c7d] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case series retrospective review. OBJECTIVE To present the treatment guideline for spinal diseases in pregnant women. SUMMARY OF BACKGROUND DATA Treatment for spinal diseases in pregnant women is a special clinical challenge because of complex medical and surgical clinical problems. METHODS We retrospectively reviewed 10 patients who underwent surgery for spinal diseases, who were diagnosed during pregnancy at our hospital from February 1992 to October 2005. Six patients had herniated lumbar discs, 3 patients had spinal tumors, and 1 patient had spinal tuberculosis. RESULTS Five patients with HLDs underwent partial hemilaminectomy and discectomy during pregnancy and maintained the pregnancy. One patient underwent posterior lumbar interbody fusion and had a therapeutic abortion 6 days after lumbar surgery. In 1 patient with hemangioblastoma at the level of T8-T9 level, prepartum surgery was performed maintaining pregnancy in gestational age, 29 weeks. In another patient with hemangioblastoma at the T10 level, a preoperative cesarean section and tumor removal surgery were performed under the same anesthesia in gestational age 34 weeks. One patient had recurrent intramedullary ependymoma at the C3-T2 level. She had the preterm baby by vaginal delivery before spinal operation in gestational age 33 weeks and underwent tumor removal surgery. One patient with tuberculous spondylitis at the level of T3-T5 level, therapeutic abortion performed in gestational age, 16 weeks because of inevitable radiation exposure during fusion surgery. CONCLUSION In most spinal diseases, including HLD and tumors, prepartum surgical treatment can be safely performed maintaining pregnancy. For patients with progressive neurologic deficit at 34 to 36 weeks gestation or later, spine surgery should be performed following the induction of delivery or a cesarean section, or at the same time.
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Zapalowicz K, Skora P, Myslinski R, Karnicki F, Radek A. Balloon kyphoplasty for painful C-7 vertebral hemangioma. J Neurosurg Spine 2008; 8:458-61. [DOI: 10.3171/spi/2008/8/5/458] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓The authors report on the efficacy of balloon kyphoplasty applied to obliteration of symptomatic cervical hemangioma. This 49-year-old woman suffered from progressive neck pain, numbness of the upper extremities, and frequent headaches. Hemangioma of the C-7 vertebral body was diagnosed. Kyphoplasty was performed successfully through a right anterolateral approach. The patient became asymptomatic, and follow-up examinations confirmed complete recovery. To the authors' knowledge, this is the first description of cervical hemangioma treated by balloon kyphoplasty.
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Affiliation(s)
| | | | - Ryszard Myslinski
- 3Diagnostics, Radiological and Isotopic Therapy of the Faculty of Nuclear Medicine, and Graphical Diagnostics, Medical University of Lodz, Poland
| | - Feliks Karnicki
- 3Diagnostics, Radiological and Isotopic Therapy of the Faculty of Nuclear Medicine, and Graphical Diagnostics, Medical University of Lodz, Poland
| | - Andrzej Radek
- 1Departments of Neurosurgery and Peripheral Nerve Surgery,
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Kiroglu Y, Benek B, Yagci B, Cirak B, Tahta K. Spinal cord compression caused by vertebral hemangioma being symptomatic during pregnancy. ACTA ACUST UNITED AC 2008; 71:487-92; discussion 492. [PMID: 18295858 DOI: 10.1016/j.surneu.2007.09.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Accepted: 09/06/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hemangioma is one of the most common benign tumors of the spine, and it remains silent in the vast majority of subjects afflicted. Pregnancy is a known risk factor for symptomatic conversion of the previously silent vertebral hemangiomas. However, the occurrence is rare with only 26 cases reported in the English medical literature. CASE DESCRIPTION A 22-year-old woman in her 36th week of gestation presented with acute onset of upper back pain and progressive paraplegia. Imaging studies revealed a T4 vertebral hemangioma, which involved the vertebral body, pedincules, transverse, and spinous process with a focal extradural extension of soft tissue component. She underwent emergent cesarean delivery and endovascular embolization, respectively. Her symptoms and neurologic deficits improved quickly. Her complaints restarted 2 years after embolization. Surgical treatment which consists of intraoperative vertebraplasty and segmental fixation was performed. The patient's postoperative recovery was excellent. CONCLUSION According to literature review and our patient's outcome, pregnancy may induce neurologic symptoms and signs in silent spinal hemangiomas. The way of management is decided by whether the neurologic deficits depend on the deformity caused by hemangioma or some other factors including vascular insufficiency.
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Affiliation(s)
- Yilmaz Kiroglu
- Department of Radiology, Pamukkale University Medical School, Denizli, Turkey
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Vijay K, Shetty AP, Rajasekaran S. Symptomatic vertebral hemangioma in pregnancy treated antepartum. A case report with review of literature. 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 2008; 17 Suppl 2:S299-303. [PMID: 18224354 DOI: 10.1007/s00586-008-0592-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Revised: 11/07/2007] [Accepted: 12/22/2007] [Indexed: 11/30/2022]
Abstract
Pregnancy related compressive myelopathy secondary to vertebral hemangioma is a rare occurrence and its treatment antepartum is rare. We report a 22-year-old lady in her 26th-week of pregnancy who was treated in two stages--antepartum with a laminectomy and posterior stabilization. This resulted in complete recovery of the neurological deficits. She delivered a normal baby after 3 months, following which a corpectomy and fusion was performed. This two-staged approach appears safe and effective in treating symptomatic vertebral haemangiomas causing neurological deficits during pregnancy. A review of relevant literature has been done.
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Affiliation(s)
- Kamath Vijay
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu, 641 011, India
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Chi JH, Bydon A, Hsieh P, Witham T, Wolinsky JP, Gokaslan ZL. Epidemiology and Demographics for Primary Vertebral Tumors. Neurosurg Clin N Am 2008; 19:1-4. [DOI: 10.1016/j.nec.2007.10.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Acosta FL, Sanai N, Chi JH, Dowd CF, Chin C, Tihan T, Chou D, Weinstein PR, Ames CP. Comprehensive Management of Symptomatic and Aggressive Vertebral Hemangiomas. Neurosurg Clin N Am 2008; 19:17-29. [DOI: 10.1016/j.nec.2007.09.010] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Chen HI, Heuer GG, Zaghloul K, Simon SL, Weigele JB, Grady MS. Lumbar vertebral hemangioma presenting with the acute onset of neurological symptoms. Case report. J Neurosurg Spine 2007; 7:80-5. [PMID: 17633493 DOI: 10.3171/spi-07/07/080] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Vertebral hemangiomas are common entities that rarely present with neurological deficits. The authors report the unusual case of a large L-3 vertebral hemangioma with epidural extension in a 27-year-old woman who presented with hip flexor and quadriceps weakness, foot drop, and leg pain. The characteristics of the mass on magnetic resonance imaging suggested an aggressive, hypervascular lesion. The patient underwent embolization of the lesion followed by direct intralesional injection of ethanol. Significant resolution of clinical symptoms was observed immediately after the procedure and at her follow-up visits. Follow-up imaging studies obtained 9 months after the procedure also documented a considerable reduction in the size of the hemangioma with minimal loss of vertebral height and a mild kyphosis at the affected level. On repeated imaging studies obtained 21 months postoperatively, the size of the hemangioma and the degree of vertebral body compression were stable. As demonstrated in this case, patients with vertebral hemangiomas can present with acute nerve root compression and signs and symptoms similar to those of disc herniation. Vertebral hemangiomas can be treated effectively with interventional techniques such as embolization and ethanol injection.
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Affiliation(s)
- H Isaac Chen
- Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
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Inamasu J, Nichols TA, Guiot BH. Vertebral hemangioma symptomatic during pregnancy treated by posterior decompression, intraoperative vertebroplasty, and segmental fixation. ACTA ACUST UNITED AC 2006; 19:451-4. [PMID: 16891983 DOI: 10.1097/00024720-200608000-00014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hemangioma is one of the most common benign tumors of the spine, and it remains silent in the vast majority of the subjects afflicted. Pregnancy is a known risk factor for symptomatic conversion of the previously dormant vertebral hemangiomas. However, the occurrence is rare with only 24 cases reported in the literature. The authors present a case of vertebral hemangioma symptomatic during the third trimester of pregnancy. The patient, a 20-year-old woman in her 33rd week of pregnancy, initially presented with acute back and bilateral leg pain, and developed the cauda equina syndrome within a week of its onset. Imaging studies revealed an L2 vertebral hemangioma, and the thecal sac was severely compressed by the epidural portion of the tumor. Emergency decompression and reconstruction surgery was undertaken 3 days after an uneventful cesarean section. The combined surgical management, consisting of laminectomy, intraoperative vertebroplasty, and segmental fixation, afforded adequate decompression, instant mechanical stability of the spine, and prompt pain elimination. The long-term efficacy of this combined treatment is unclear and needs to be followed cautiously.
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Affiliation(s)
- Joji Inamasu
- Department of Neurosurgery, University of South Florida College of Medicine, Tampa, FL 33606, USA.
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