1
|
Kesavapisharady K, Divakar G, George T, E R J, Venkat Hariharan E. Compressive vertebral hemangiomas with neurological deficits: diagnosis, surgical strategies and long term outcome. Br J Neurosurg 2024; 38:735-745. [PMID: 34435527 DOI: 10.1080/02688697.2021.1967878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/29/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Compressive vertebral hemangiomas with neurological deficits (CVHND) form a rare, unique subset of lesions comprising of differing clinico-imaging findings, pathologic behavior and treatment, when compared to the commoner and usually incidental intra-osseus vertebral hemangiomas (VH). Though various surgical strategies and a broad array of adjuncts have evolved and changed over the years, there is paucity of comprehensive data from sizeable series of such patients treated surgically with long term follow up. The purpose of this study is to device an optimum management strategy in CVHND based on our surgical experience. MATERIALS AND METHODS The data from electronic medical records of 26 consecutive patients operated in our department from 2009 to 2019 were retrospectively analyzed. RESULTS There were 11 males and 15 females with a mean age of 34.7 years. Neurological examination revealed paraparesis or paraplegia with myelopathy in all patients with Frankel score of B, C and D in 1 (3.9%), 11 (42.3%) and 14 (53.8%) patients respectively. Sixteen patients (61%) underwent laminectomy and gross total excision of extradural soft tissue component, 7 (27%) laminectomy with posterolateral fusion, three (12%) underwent additional anterior interbody support. The mean follow up was 72.4 months and at last follow-up 24 patients (92%) were Frankel E. Symptomatic recurrence was seen in two patients operated early in the series, they underwent re-surgery, gross total excision with posterolateral fusion, remaining neurologically intact at last follow up. CONCLUSIONS Pre-operative embolization, surgical excision of extradural component and intra-operative vertebroplasty form the mainstay of treatment for CVHND. Instrumented posterolateral fusion with optional anterior interbody support accomplished through the same approach is required only in a minority of cases. The long-term outcome following timely and appropriate treatment is excellent. Anterior or anterolateral approaches for intervertebral support and radical procedures like total en-bloc spondylectomy (TES) are not usually required.
Collapse
Affiliation(s)
- Krishnakumar Kesavapisharady
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Ganesh Divakar
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Tobin George
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Jayadevan E R
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Easwer Venkat Hariharan
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| |
Collapse
|
2
|
Kato K, Teferi N, Challa M, Eschbacher K, Yamaguchi S. Vertebral hemangiomas: a review on diagnosis and management. J Orthop Surg Res 2024; 19:310. [PMID: 38789994 PMCID: PMC11127296 DOI: 10.1186/s13018-024-04799-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/18/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Vertebral hemangiomas (VHs) are the most common benign tumors of the spinal column and are often encountered incidentally during routine spinal imaging. METHODS A retrospective review of the inpatient and outpatient hospital records at our institution was performed for the diagnosis of VHs from January 2005 to September 2023. Search filters included "vertebral hemangioma," "back pain," "weakness," "radiculopathy," and "focal neurological deficits." Radiographic evaluation of these patients included plain X-rays, CT, and MRI. Following confirmation of a diagnosis of VH, these images were used to generate the figures used in this manuscript. Moreover, an extensive literature search was conducted using PubMed for the literature review portion of the manuscript. RESULT VHs are benign vascular proliferations that cause remodeling of bony trabeculae in the vertebral body of the spinal column. Horizontal trabeculae deteriorate leading to thickening of vertical trabeculae which causes a striated appearance on sagittal magnetic resonance imaging (MRI) and computed tomography (CT), "Corduroy sign," and a punctuated appearance on axial imaging, "Polka dot sign." These findings are seen in "typical vertebral hemangiomas" due to a low vascular-to-fat ratio of the lesion. Contrarily, atypical vertebral hemangiomas may or may not demonstrate the "Corduroy" or "Polka-dot" signs due to lower amounts of fat and a higher vascular component. Atypical vertebral hemangiomas often mimic other neoplastic pathologies, making diagnosis challenging. Although most VHs are asymptomatic, aggressive vertebral hemangiomas can present with neurologic sequelae such as myelopathy and radiculopathy due to nerve root and/or spinal cord compression. Asymptomatic vertebral hemangiomas do not require therapy, and there are many treatment options for vertebral hemangiomas causing pain, radiculopathy, and/or myelopathy. Surgery (corpectomy, laminectomy), percutaneous techniques (vertebroplasty, sclerotherapy, embolization), and radiotherapy can be used in combination or isolation as appropriate. Specific treatment options depend on the lesion's size/location and the extent of neural element compression. There is no consensus on the optimal treatment plan for symptomatic vertebral hemangioma patients, although management algorithms have been proposed. CONCLUSION While typical vertebral hemangioma diagnosis is relatively straightforward, the differential diagnosis is broad for atypical and aggressive lesions. There is an ongoing debate as to the best approach for managing symptomatic cases, however, surgical resection is often considered first line treatment for patients with neurologic deficit.
Collapse
Affiliation(s)
- Kyle Kato
- University of Iowa Carver, College of Medicine, Iowa City, IA, USA.
| | - Nahom Teferi
- Department of Neurosurgery, University of Iowa Carver, College of Medicine, Iowa City, IA, USA
| | - Meron Challa
- University of Iowa Carver, College of Medicine, Iowa City, IA, USA
| | - Kathryn Eschbacher
- Department of Pathology, University of Iowa Carver, College of Medicine,, Iowa City, IA, USA
| | - Satoshi Yamaguchi
- Department of Neurosurgery, University of Iowa Carver, College of Medicine, Iowa City, IA, USA
| |
Collapse
|
3
|
Lofrese G, Cultrera F, Ricciardi L, Visani J, Tosatto L, Ruggiero M, Haznedari N, Menetti F. Preoperative elastoplasty of aggressive vertebral hemangiomas in elderly patients: a new strategy for reducing intraoperative bleeding and complications. 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 2024; 33:1921-1929. [PMID: 38491218 DOI: 10.1007/s00586-024-08201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE Preoperative elastoplasty could be an alternative strategy for treating aggressive vertebral hemangiomas (VHs) in frail patients needing for spinal cord decompression, combining the advantages of embolization and vertebroplasty. METHODS Three elderly patients with spinal cord compression from thoracic aggressive VHs underwent XperCT-guided percutaneous injection of silicone (VK100), filling the whole affected vertebra, followed by a decompressive laminectomy. At 12-months follow-up no recurrences, vertebral collapse or segmental kyphosis were noted at the CT scans, with patients reporting an improvement of preoperative neurological deficits, VAS and Smiley-Webster pain scale (SWPS) parameters. RESULTS With its elastic modulus, non-exothermic hardening, and lower viscosity than PMMA, VK100 allowed a preoperative augmentation of the affected vertebral body, pedicles, and laminae without complications, with a controlled silicone delivery even in part of VH's epidural components thanks to XperCT-guidance. CONCLUSION When facing highly bony erosive VH encroaching the spinal canal, VK100 combines the advantages of embolization and vertebroplasty especially in elderly patients, permeating the whole VH's angioarchitecture, significantly reducing tumor.
Collapse
Affiliation(s)
- Giorgio Lofrese
- Neurosurgery Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Francesco Cultrera
- Neurosurgery Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Luca Ricciardi
- Neurosurgery Division, Sapienza University, Via di Grottarossa 1035, Rome, Italy.
| | - Jacopo Visani
- Neurosurgery Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Luigino Tosatto
- Neurosurgery Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Maria Ruggiero
- Neuroradiology Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Nicolò Haznedari
- Neuroradiology Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Federico Menetti
- Neuroradiology Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Wang LJ, Zou HM, Hou F, Wang GX, Gao CP. Aggressive vertebral hemangiomas contain no adipose tissue resulting in thoracic spine kyphosis: A case report. Medicine (Baltimore) 2024; 103:e37885. [PMID: 38640290 PMCID: PMC11029966 DOI: 10.1097/md.0000000000037885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/15/2024] [Accepted: 03/22/2024] [Indexed: 04/21/2024] Open
Abstract
RATIONALE Aggressive vertebral hemangiomas (AVHs) destroy continuous vertebral bodies and intervertebral discs and resulting in spinal kyphosis is extremely rare. The very aggressive behavior was attributable to its significant vascular component and contained no adipose tissue. PATIENT CONCERNS We report a case of thoracic spine kyphosis of AVHs with multiple vertebral bodies and intervertebral disc destruction in a 45-year-old woman. DIAGNOSES Based on the imaging studies, the patient underwent surgical removal of this lesion and spinal reconstruction. Histopathology consistent with vertebral hemangioma and contained no adipose. INTERVENTIONS The patient underwent surgical removal of the lesion and spinal reconstruction. After subperiosteal dissection of the paraspinal muscles and exposure of the laminae, the laminae of the T5-7 vertebrae were removed and exposing the lesion. The lesion was soft and showed cystic changes, completely curetted and autogenous bone was implanted. Vertebroplasty was performed through T3-T9 pedicles bilaterally. Pedicle screw fixation was performed for segmental fixation and fusion. OUTCOMES After 9 days of operation, the incision healed cleanly and free of pain. She was discharged in good general condition. The patient remained asymptomatic after follow-up 6 months of postoperative. LESSONS AVHs destroy multiple vertebral bodies and intervertebral discs and resulting in spinal kyphosis is extremely rare.
Collapse
Affiliation(s)
- Liang-Jie Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hong-Mei Zou
- Department of Radiology, The Affiliated Qingdao Third People's Hospital, Qingdao University, Qingdao, China
| | - Feng Hou
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guan-Xi Wang
- Department of Radiology, Songshan Hospital of Qingdao University Medical College University, Qingdao, China
| | - Chuan-Ping Gao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| |
Collapse
|
6
|
Burgess L, Malone J, dos Santos MP, Sinclair J, Zalay O, Malone S. Clinical and radiographic response of a paravertebral hemangioma to radiotherapy. Radiol Case Rep 2024; 19:988-993. [PMID: 38155745 PMCID: PMC10751835 DOI: 10.1016/j.radcr.2023.11.032] [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: 05/24/2023] [Revised: 11/07/2023] [Accepted: 11/11/2023] [Indexed: 12/30/2023] Open
Abstract
Hemangiomas can arise anywhere in the body. While vertebral hemangiomas are common, atypical hemangiomas with paraspinal and epidural extension are rare. We present a case of a patient who presented with persistent cough and anorexia from a paravertebral hemangioma that invaded the adjacent vertebrae and neural foramen causing moderate spinal canal stenosis. She was treated with stereotactic body radiotherapy to prevent the development of symptomatic spinal cord compression. The hemangioma underwent significant shrinkage and her cough resolved. This case demonstrates impressive and sustained clinical and radiographic response of a paraspinal hemangioma to stereotactic body radiotherapy.
Collapse
Affiliation(s)
- Laura Burgess
- Department of Radiology, Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Radiology, Division of Radiation Oncology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Julia Malone
- Department of Radiology, Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Radiology, Division of Radiation Oncology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marlise P. dos Santos
- Department of Radiology, Radiation Oncology and Medical Physics, Section of Neuroradiology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Surgery Divisions of Neurosurgery and Interventional Neuroradiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - John Sinclair
- Department of Surgery, Division of Neurosurgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Osbert Zalay
- Department of Radiology, Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Radiology, Division of Radiation Oncology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shawn Malone
- Department of Radiology, Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Radiology, Division of Radiation Oncology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
7
|
Tedesco G, Noli LE, Griffoni C, Ghermandi R, Facchini G, Peta G, Papalexis N, Asunis E, Pasini S, Gasbarrini A. Electrochemotherapy in Aggressive Hemangioma of the Spine: A Case Series and Narrative Literature Review. J Clin Med 2024; 13:1239. [PMID: 38592093 PMCID: PMC10932223 DOI: 10.3390/jcm13051239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: this case series and literature review aims to evaluate the efficacy and safety of electrochemotherapy in the management of aggressive spinal hemangiomas, presenting two distinct cases. (2) Methods: we present two cases of spinal aggressive hemangioma which were refractory to conventional treatments and underwent electrochemotherapy. Case 1 involves a 50-year-old female who presented with an aggressive spinal hemangioma of L1, who previously underwent various treatments including surgery, radio-chemotherapy, and arterial embolization. Case 2 describes a 16-year-old female with a T12 vertebral hemangioma, previously treated with surgery and stabilization, who faced limitations in treatment options due to her young age and the location of the hemangioma. (3) Results: in Case 1, electrochemotherapy with bleomycin was administered following the failure of previous treatments and resulted in the reduction of the lesion size and improvement in clinical symptoms. In Case 2, electrochemotherapy was chosen due to the risks associated with other treatments and was completed without any adverse events. Both cases demonstrated the potential of electrochemotherapy as a viable treatment option for spinal hemangiomas, especially in complex or recurrent cases. (4) Conclusions: electrochemotherapy with bleomycin is a promising treatment for aggressive spinal hemangiomas when conventional therapies are not feasible or have failed. Further research is needed to establish definitive protocols and long-term outcomes of electrochemotherapy in spinal hemangioma management.
Collapse
Affiliation(s)
- Giuseppe Tedesco
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Luigi Emanuele Noli
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche Bologna, Bellaria Hospital, 40139 Bologna, Italy;
| | - Cristiana Griffoni
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Riccardo Ghermandi
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.F.); (G.P.); (N.P.)
| | - Giuliano Peta
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.F.); (G.P.); (N.P.)
| | - Nicolas Papalexis
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.F.); (G.P.); (N.P.)
| | - Emanuela Asunis
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Stefano Pasini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Alessandro Gasbarrini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| |
Collapse
|
8
|
Subramaniam MH, Moirangthem V, Venkatesan M. Response to the Letter to the Editor Concerning "Management of Aggressive Vertebral Haemangioma and Assessment of Differentiating Pointers Between Aggressive Vertebral Haemangioma and Metastases-A Systematic Review" by Subramaniam et al. Global Spine J 2024; 14:349-350. [PMID: 36519352 PMCID: PMC10676154 DOI: 10.1177/21925682221145686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
|
9
|
Swaminathan G, Jonathan GE, Mani SA, Keshava SN, Moses V, Prabhu K. Surgical strategies in the management of aggressive spinal haemangiomas: Retrospective case series with literature review and a practical treatment algorithm. BRAIN & SPINE 2023; 4:102736. [PMID: 38510623 PMCID: PMC10951693 DOI: 10.1016/j.bas.2023.102736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/21/2023] [Accepted: 12/11/2023] [Indexed: 03/22/2024]
Abstract
Purpose We studied the clinico-radiological features and treatment outcomes of patients with aggressive spinal haemangiomas. Methods We undertook a retrospective review of 24 patients with aggressive spinal haemangiomas managed at our centre from 2004 to 2016. The cohort was divided into two groups. Group1 included patients managed from 2004 to 2009 while Group 2 was those treated between 2010 and 2016. Clinicoradiological features and treatment outcomes were studied. Results Back pain (24/24) and myelopathy (18/24) were the most common presenting complaints. Over 80% (20/24) of patients, had involvement of the thoracic spine and more than 50% (13/24) had severe spasticity, being Nurick grade 4&5 at presentation. The various treatment modalities used were laminectomy with or without instrumented posterior fusion (10/24), corpectomy with instrumented fusion (10/24) and alcohol injection alone (4/24). Patients who were treated with surgery had significant clinical improvement at follow-up in both groups. Patients who underwent alcohol injection did not have any improvement in symptoms at follow-up. There was a change in our strategy in the later part of the series from a two staged anterior and posterior approach to a single staged posterior-only approach to address vertebral body disease with preoperative angioembolization. Conclusion Haemangiomas are benign lesions with locally aggressive behavior in some cases. Results of conservative approaches such as alcohol injection in management of these lesions are discouraging. Aggressive surgical decompression combined with preoperative adjuncts such as angioembolization with or without stabilization reduces intra operative blood loss and results in good neurological recovery even in patients with severe myelopathy.
Collapse
Affiliation(s)
- Ganesh Swaminathan
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | | | | | | | - Vinu Moses
- Department of Radiodiagnosis, Christian Medical College, Vellore, India
| | - Krishna Prabhu
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| |
Collapse
|
10
|
Diarra MD, Zhang Z, Wang Z, Yinwang E, Li H, Wang S, Lin P, Huang X, Ye Z. Surgical Options for Aggressive Vertebral Hemangiomas:A case series, literature review and treatment recommendations. J Bone Oncol 2023; 43:100515. [PMID: 38125609 PMCID: PMC10730854 DOI: 10.1016/j.jbo.2023.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose We retrospectively study twenty-nine surgical cases of aggressive vertebral hemangiomas (AVHs) with neurological deficits and extradural compression to determine the optimal surgical treatment strategy for AVHs at a single institution. Methods Patients with AVHs with neurological deficits who underwent partial tumor resection plus decompression with or without vertebroplasty (VP), and radiotherapy between 2010 and 2021 were included in this study. Clinical characteristics, surgical outcomes, and follow-up data of the patients were reviewed retrospectively. Results Twenty-nine AVH cases with neurological deficits and spinal instability were included in this study and treated surgically. The mean operation time of patients with decompression surgery plus VP (Groupe A) was 215.9 (120-265 min), shorter than that of decompression surgery without VP (Group B) 240.2 (120-320 min). Intraoperative blood loss was 273.3 (100-550 mL) in group A and 635.3 (200-1600 mL) in group B. In addition, a significant reduction in blood loss was observed in group A compared to the group B (p=0.0001). All patients experienced immediate pain relief and improvement in their neurological symptoms. Neurological function was assessed by the Frankel score, ASIA score, and the visual analogue scale (VAS) pain score decreased from 7.4 (4-9) to 1.3 (0-3). Of twenty-nine patients in this study, only 7% (2/29 patients) showed signs of recurrence. Conclusion Decompression plus VP achieve good tumor control and decrease surgical complication. Preoperative vascular embolization and VP can reduce intraoperative bleeding in the treatment of AVH surgery. Moreover, postoperative radiotherapy seems to be a good technique to prevent tumor recurrence.
Collapse
Affiliation(s)
- Mohamed Diaty Diarra
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Zengjie Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Zhan Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Eloy Yinwang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Hengyuan Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Shengdong Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Peng Lin
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Xin Huang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Zhaoming Ye
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| |
Collapse
|
11
|
Endo M, Yamamoto S, Yata S, Takasugi S, Tsukamoto K, Makishima J, Kamata Y, Kishimoto M, Shinano K, Fujii S, Ohuchi Y, Tanishima S. Percutaneous ethanolamine oleate sclerotherapy for aggressive vertebral hemangioma: A case report. Radiol Case Rep 2023; 18:2971-2974. [PMID: 37520383 PMCID: PMC10375363 DOI: 10.1016/j.radcr.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/03/2023] [Accepted: 06/08/2023] [Indexed: 08/01/2023] Open
Abstract
Vertebral hemangiomas are the most common benign lesion of the spine which are often an asymptomatic incidental finding. However, a few hemangiomas are aggressive and characterized by bone expansion and extraosseous extension into the paraspinal and epidural spaces. We report the case of a patient presenting an aggressive vertebral hemangioma causing back pain and bilateral numbness of the legs. Among various treatment modalities, a minimally invasive percutaneous sclerotherapy procedure using ethanolamine oleate under computed tomography and fluoroscopic guidance was safely and successfully performed with good clinical outcomes.
Collapse
Affiliation(s)
- Masayuki Endo
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Tottori University, 36-1 Nishi-cho, Yonago Tottori 683-0854 Japan
| | - Shuichi Yamamoto
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Tottori University, 36-1 Nishi-cho, Yonago Tottori 683-0854 Japan
| | - Shinsaku Yata
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Tottori University, 36-1 Nishi-cho, Yonago Tottori 683-0854 Japan
| | - Shohei Takasugi
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Tottori University, 36-1 Nishi-cho, Yonago Tottori 683-0854 Japan
| | - Kazumichi Tsukamoto
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Tottori University, 36-1 Nishi-cho, Yonago Tottori 683-0854 Japan
| | - Jun Makishima
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Tottori University, 36-1 Nishi-cho, Yonago Tottori 683-0854 Japan
| | - Yuji Kamata
- Department of Radiology, Matsue Red Cross Hospital, 200 Horomachi, Matsue, Shimane, Japan
| | - Misato Kishimoto
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Tottori University, 36-1 Nishi-cho, Yonago Tottori 683-0854 Japan
| | - Kentaro Shinano
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Tottori University, 36-1 Nishi-cho, Yonago Tottori 683-0854 Japan
| | - Shinya Fujii
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Tottori University, 36-1 Nishi-cho, Yonago Tottori 683-0854 Japan
| | - Yasufumi Ohuchi
- Department of Radiology, Matsue Red Cross Hospital, 200 Horomachi, Matsue, Shimane, Japan
| | - Shinji Tanishima
- Division of Orthopedic Surgery, Department of Sensory of Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, Yonago Tottori, Japan
| |
Collapse
|
12
|
Teferi N, Chowdhury AJ, Mehdi Z, Challa M, Eschbacher K, Bathla G, Hitchon P. Surgical management of symptomatic vertebral hemangiomas: a single institution experience and literature review. Spine J 2023; 23:1243-1254. [PMID: 37059306 DOI: 10.1016/j.spinee.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/13/2023] [Accepted: 04/07/2023] [Indexed: 04/16/2023]
Abstract
Vertebral hemangiomas (VHs), formed from a vascular proliferation in bone marrow spaces limited by bone trabeculae, are the most common benign tumors of the spine. While most VHs remain clinically quiescent and often only require surveillance, rarely they may cause symptoms. They may exhibit active behaviors, including rapid proliferation, extending beyond the vertebral body, and invading the paravertebral and/or epidural space with possible compression of the spinal cord and/or nerve roots ("aggressive" VHs). An extensive list of treatment modalities is currently available, but the role of techniques such as embolization, radiotherapy, and vertebroplasty as adjuvants to surgery has not yet been elucidated. There exists a need to succinctly summarize the treatments and associated outcomes to guide VH treatment plans. In this review article, a single institution's experience in the management of symptomatic VHs is summarized along with a review of the available literature on their clinical presentation and management options, followed by a proposal of a management algorithm.
Collapse
Affiliation(s)
- Nahom Teferi
- Department of Neurosurgery, College of Medicine, University of Iowa Carver, 200 Hawkins Drive, Iowa City, Iowa 52242 USA.
| | - A J Chowdhury
- College of Medicine, University of Iowa Carver, 200 Hawkins Drive, Iowa City, Iowa 52242 USA
| | - Zain Mehdi
- College of Medicine, University of Iowa Carver, 200 Hawkins Drive, Iowa City, Iowa 52242 USA
| | - Meron Challa
- College of Medicine, University of Iowa Carver, 200 Hawkins Drive, Iowa City, Iowa 52242 USA
| | - Kathryn Eschbacher
- Department of Pathology, College of Medicine, University of Iowa Carver, 200 Hawkins Drive, Iowa City, Iowa 52242 USA
| | - Girish Bathla
- Department of Radiology, Mayo clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Patrick Hitchon
- Department of Neurosurgery, College of Medicine, University of Iowa Carver, 200 Hawkins Drive, Iowa City, Iowa 52242 USA
| |
Collapse
|
13
|
Sekar A, Datta D, Parameshwar, Gulla KM, Bansal S. Aggressive vertebral hemangiomas in children. Childs Nerv Syst 2023; 39:571-575. [PMID: 36416953 DOI: 10.1007/s00381-022-05760-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Aggressive vertebral hemangiomas are rare tumors in children, usually occurring in the thoracic spine that can cause significant neurological morbidity. They are technically difficult to treat with significant risk of blood loss during surgery. METHODS We describe a case of aggressive vertebral hemangioma managed in our institution. We performed a literature review of reported cases of aggressive vertebral hemangiomas in pediatric age group. We discuss the clinical presentation, diagnosis, and management of these lesions. RESULTS We identified 23 cases of aggressive vertebral reported in children. Neurodeficit was the most common presentation, and the most common location was the thoracic spine. Surgery was the most common modality of treatment. All the patients reported in literature had improvement in their symptoms after treatment. CONCLUSION Although technically challenging, aggressive vertebral hemangiomas have a good outcome after treatment. Treatment should be tailored to the individual patient. Further studies are needed to determine the optimum treatment strategy.
Collapse
Affiliation(s)
- Arunkumar Sekar
- Department of Neurosurgery, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Odisha, 751019, India.
| | - Debajyoti Datta
- Department of Neurosurgery, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Parameshwar
- Department of Neurosurgery, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Krishna Mohan Gulla
- Department of Pediatrics, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Sumit Bansal
- Department of Neurosurgery, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| |
Collapse
|
14
|
K GP, Shetty AP, K S SVA, Kavishwar R, Kanna RM, Rajasekaran S. In Vertebral Hemangiomas with Neurological Deficit, Is a Less Extensive Approach Adequate. Asian Spine J 2023; 17:37-46. [PMID: 35989504 PMCID: PMC9977982 DOI: 10.31616/asj.2021.0481] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/02/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN This was a retrospective study. PURPOSE To analyze the surgical and neurological outcomes following surgical decompression in patients with aggressive vertebral hemangioma (AVH) presenting with neurological deficit and to determine whether a less extensive approach is appropriate. OVERVIEW OF LITERATURE AVHs are a rare subset of benign vascular tumors frequently presenting with neurological deficit because of spinal cord compression. Though the results of surgical management have improved over time, there is a lack of consensus on the ideal management in this group of patients. METHODS Twenty-one patients who underwent surgery for AVH between 2009 and 2018 were analyzed. Demographic and clinical details of patients were retrieved from hospital information system. Imaging information (i.e., radiography, computed tomography, magnetic resonance imaging) of all patients was accessed and analyzed in picture archiving and communication system. Tumor staging was performed using Enneking and Weinstein-Boriani-Biagini classifications and Spinal Instability Neoplastic Score. At followup, neurological and radiological evaluations were performed. RESULTS Twenty-one patients (13 [61.9%] females and 8 [38.1%] males) were included with a mean age of 44.29 years (range, 14-72 years). All patients in the study had neurological deficit. Back pain was present in 80.9% of patients. Mean duration of symptoms was 4.6 months (range, 1 day to 10 months). Most common lesion location was thoracic spine (n=12), followed by thoracolumbar (D11- L2; n=7) and lumbar (n=2) regions. Ten patients had multiple level lesions. All patients underwent preoperative embolization. Nine patients underwent intralesional spondylectomy with reconstruction; another nine patients underwent stabilization, decompression, and vertebroplasty; three patients underwent decompression and stabilization. Neurology improved in all patients, and only one case of recurrence was noted in a mean follow-up of 55.78±25 months (range, 24-96 months). CONCLUSIONS In AVH, good clinical and neurological outcomes with low recurrence rates can be achieved using less extensive procedures, such as posterior instrumented decompression with vertebroplasty and intralesional tumor resection.
Collapse
Affiliation(s)
- Guna Pratheep K
- Department of Spine Surgery, Ganga Medical Centre and Hospitals, Coimbatore, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals, Coimbatore, India
| | - Sri Vijay Anand K S
- Department of Spine Surgery, Ganga Medical Centre and Hospitals, Coimbatore, India
| | - Rohit Kavishwar
- Department of Spine Surgery, Ganga Medical Centre and Hospitals, Coimbatore, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals, Coimbatore, India
| | | |
Collapse
|
15
|
Muacevic A, Adler JR, Wichmann W, Magagna-Poveda A, Fandino J. Lumbar Epidural Cavernous Hemangioma: A Case Report and Review of the Literature. Cureus 2023; 15:e33677. [PMID: 36788892 PMCID: PMC9918856 DOI: 10.7759/cureus.33677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/14/2023] Open
Abstract
Pure epidural cavernous hemangioma (ECH) of the spine are rare and account for only 4% of all epidural spinal lesions. We report a case of epidural cavernoma at L3/4 presenting with L4 radiculopathy. Radiological, intraoperative findings and histopathology are presented. We present the case of a 56-year-old man who was admitted with a right L4 radiculopathy including an M4 paresis of the right leg, hypoesthesia L4, and radicular pain. Magnetic resonance imaging (MRI) confirmed an extradural lesion L3/4 partially expanding into the right intervertebral foramen. The lesion had a heterogeneous signal, isointense on T1-weighted and hyperintense on proton density (PD) and T2-weighted images. At surgery, an epidural, ovoid, gray-red, soft mass, lightly adherent to the dura and extending to the right L4 foramen was observed. Findings in the histological examination indicated a cavernous hemangioma without signs of hemorrhage. Symptoms and paresis improved rapidly after surgery. The follow-up MRI showed complete resection of the lesion with no signs of radicular compression. Spinal ECH should be considered as a cause of chronic lumbar radiculopathy with atypical radiological findings. Early diagnosis and total removal of the spinal ECH might prevent hemorrhage and neurological deficits. Fewer than 50 cases of lumbar epidural spinal hemangioma have been reported until today, and our case report is adding valuable knowledge to the existing literature.
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Lisitsky IY, Lychagin AV, Zarov AY, Korkunov AL, Cherepanov VG, Vyzankin IA. [Total resection of aggressive hemangioma of thoracic spine: case report and literature review]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:92-97. [PMID: 37325831 DOI: 10.17116/neiro20238703192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The authors report total resection of aggressive hemangioma of Th7 vertebra in a patient with severe conduction disorders in the lower extremities. Total Th7 spondylectomy (Tomita procedure) was performed. This method provided simultaneous en bloc resection of the vertebra and tumor via the same approach, eliminate spinal cord compression and perform stable circular fusion. Postoperative follow-up period was 6 months. Neurological disorders were evaluated using the Frankel scale, pain syndrome - visual analogue scale, muscle strength - MRC scale. Pain syndrome and motor disorders in the lower extremities regressed in 6 months after surgery. CT confirmed spinal fusion without signs of continued tumor growth. Literature data on surgical treatment of aggressive hemangiomas are reviewed.
Collapse
Affiliation(s)
- I Yu Lisitsky
- Sechenov First Moscow State Medical University, Russia, Moscow
| | - A V Lychagin
- Sechenov First Moscow State Medical University, Russia, Moscow
| | - A Yu Zarov
- Sechenov First Moscow State Medical University, Russia, Moscow
| | - A L Korkunov
- Sechenov First Moscow State Medical University, Russia, Moscow
| | - V G Cherepanov
- Sechenov First Moscow State Medical University, Russia, Moscow
| | - I A Vyzankin
- Sechenov First Moscow State Medical University, Russia, Moscow
| |
Collapse
|
18
|
Wang GX, Chen YQ, Wang Y, Gao CP. Atypical aggressive vertebral hemangioma of the sacrum with postoperative recurrence: A case report. World J Clin Cases 2022; 10:12648-12653. [PMID: 36579090 PMCID: PMC9791517 DOI: 10.12998/wjcc.v10.i34.12648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/05/2022] [Accepted: 11/07/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Aggressive vertebral hemangioma (VH) is an uncommon lesion in the adult population. The vast majority of aggressive VHs have typical radiographic features. However, preoperative diagnosis of atypical aggressive VH may be difficult. Aggressive VHs are likely to recur even with en bloc resection.
CASE SUMMARY A 52-year-old woman presented with a 3-mo history of numbness and pain in her right lower extremity. Physical examination showed sacral tenderness and limited mobility, and the muscle strength was grade 4 in the right digital flexor. Computed tomography revealed osteolytic bone destruction from S1 to S2. Magnetic resonance imaging (MRI) showed that the mass was compressing the dural sac; it was heterogeneously hypointense on T1-weighted MRI and hyperintense on T2-weighted MRI, and gadolinium contrast enhancement showed that the tumor was heterogeneously enhanced and invading the vertebral endplate of S1. The patient developed progressive back pain and numbness in the bilateral extremities 6 mo postoperatively, and MRI examination showed recurrence of the mass. The mass was larger in size than before the operation, and it was extending into the spinal canal.
CONCLUSION The radiographic findings of atypical aggressive VH include osteolytic vertebral bone destruction, extension of the mass into the spinal canal, and heterogeneous signal intensity on T1-, T2-, and enhanced T1-weighted MRI. These characteristics make preoperative diagnosis difficult, and biopsy is necessary to verify the lesion. Surgical decompression and gross total resection are recommended for treatment of aggressive VH. However, recurrence is inevitable in some cases.
Collapse
Affiliation(s)
- Guan-Xi Wang
- Department of Radiology, Songshan Hospital of Qingdao University Medical College University, Qingdao 266000, Shandong Province, China
| | - Yun-Qing Chen
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Yan Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Chuan-Ping Gao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| |
Collapse
|
19
|
De Marco R, Piatelli G, Rossi A, Nasto LA, Pavanello M. Stepwise approach for vertebral hemangioma in children: case-reports and treatment algorithm proposal. 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 2022; 31:3748-3758. [PMID: 35608706 DOI: 10.1007/s00586-022-07241-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/03/2022] [Accepted: 04/20/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To discuss a treatment algorithm for vertebral hemangioma in children. METHODS Vertebral hemangioma (VH) is a rare cause of low back pain in children. In most cases, VHs present as incidental findings and do not require invasive diagnostic procedure. In case of symptomatic presentation, different approaches can be used. Over the years, we have developed a treatment algorithm for VH in children based on our clinical experience. In this manuscript, we propose a stepwise approach to treatment of VHs based on tumor extension and the degree of spinal cord/nerves compression with or without neurological deficit. RESULTS According to the proposed protocol, we discuss two cases of aggressive VH treated at our institution by a multidisciplinary team. The first case is about a young girl treated with percutaneous one-level posterior instrumentation followed by medical adjuvant therapy for an L4 "Stage 3" VH. The second case is about an 8-year-old boy with rapidly progressive myelopathy due to T11 "Stage 4" VH treated with a combined anterior and posterior surgery (i.e., posterior decompression and fusion followed by vertebrectomy and expandable cage placement) after preoperative arterial embolization. CONCLUSION Given the lack of international guidelines and consensus with regard to treatment of VHs in children, we believe our proposal for a stepwise approach combining clinical and radiological characteristics of the lesion may help guide treatment of this condition in children.
Collapse
Affiliation(s)
- Raffaele De Marco
- Department of Neurosurgery, IRCCS Istituto "G. Gaslini", via G. Gaslini 5, 16148, Genoa, Italy.
- Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute e Della Scienza" University Hospital, University of Turin, Via Cherasco 15, 10126, Turin, Italy.
| | - Gianluca Piatelli
- Department of Neurosurgery, IRCCS Istituto "G. Gaslini", via G. Gaslini 5, 16148, Genoa, Italy
| | - Andrea Rossi
- Interventional Radiology and Neuroradiology Unit, IRCSS Istituto "G. Gaslini", via G.Gaslini 5, 16148, Genoa, Italy
| | - Luigi Aurelio Nasto
- Department of Paediatric Orthopaedics, IRCCS Istituto "G. Gaslini", via G. Gaslini 5, 16148, Genoa, Italy
| | - Marco Pavanello
- Department of Neurosurgery, IRCCS Istituto "G. Gaslini", via G. Gaslini 5, 16148, Genoa, Italy
| |
Collapse
|
20
|
Subramaniam MH, Moirangthem V, Venkatesan M. Management of Aggressive Vertebral Haemangioma and Assessment of Differentiating Pointers Between Aggressive Vertebral Haemangioma and Metastases - A Systematic Review. Global Spine J 2022; 13:1120-1133. [PMID: 36317457 DOI: 10.1177/21925682221137026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Vertebral haemangioma has been classified into typical and aggressive vertebral haemangioma (AVH). Management options for AVH are many and the clinician has decision dilemma in choosing the right one. Metastases mimic AVH in clinical and radiological presentation. Differentiating pointers between them has not been clearly delineated in literature. Aim of our review is to identify treatment options; to formulate a management algorithm for AVH based on clinical presentation and to identify radiological differentiating pointers between them. METHODS Systematic review was conducted according to PRISMA guidelines. We systematically reviewed all available literature from the year 2001 to 2020. Relevant articles were identified as per laid down criteria from the medical databases. After inclusion, first and second authors went through full text of each included article. RESULTS Of 139 studies reviewed, eight met our criteria for review of management and three separate studies for radiological differentiating pointers. 99 patients with 88 AVH had undergone treatment. Back pain with myelopathy is the presenting symptom in majority of patients. Patients with backpain - myelopathic symptoms had improved following surgery; patients with back pain alone had improved with either percutaneous vertebroplasty or CT guided alcohol ablation. Dynamic contrast MRI, Diffusion weighted MRI and ratio of signal intensity between T1w and fat suppression T1w MR help the clinician in differentiating them. CONCLUSION Management of AVH can be based on the patient's clinical presentation. Patients presenting with AVH and back pain can be managed with either Percutaneous vertebroplasty or CT guided alcohol ablation. Patients presenting with AVH and neurological symptoms could be managed with surgery. Dynamic contrast enhanced MR, Diffusion weighted MR, ratio of signal intensity between T1w and Fat suppression T1w MR imaging could help the clinician in differentiating the two before contemplating biopsy. GRADE PRACTICE RECOMMENDATION C.
Collapse
|
21
|
Brindisino F, Scrimitore A, Pennella D, Bruno F, Pellegrino R, Maselli F, Lena F, Giovannico G. Aggressive Vertebral Hemangioma and Spinal Cord Compression: A Particular Direct Access Case of Low Back Pain to Be Managed-A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13276. [PMID: 36293852 PMCID: PMC9603351 DOI: 10.3390/ijerph192013276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Hemangiomas are the most common benign tumours affecting the spine, with an incidence of 10-12% of the general population. Although most hemangiomas are asymptomatic, there are aggressive forms which can develop symptoms, leading patients to show signs of disability. This case report aims to highlight the importance of red flags screening, and to report the physiotherapist's clinical reasoning that led him to refer his patient to other healthcare professionals. This case also illustrated the pre- and post-surgical treatment of a specific low back pain case in a patient affected by aggressive vertebral hemangioma and spinal cord compression. The patient is a 52-year-old man, who reported intense pain in his sacral region about three months prior, which worsened while in sitting position. The physiotherapist proceeded with a complete medical history investigation and clinical examination. After an impaired neurological examination, the patient was referred to another health professional, who diagnosed multiple vertebral hemangiomas in the patient's lumbosacral tract. The therapeutic intervention included the patient's post-surgical rehabilitation following a vascular embolization. This case report shows the importance of proper patient screening. Indeed, during patients' assessment, it is paramount to recognize red flags and to investigate them appropriately. An early referral of patients with conditions that require the support and expertise of other professionals can lead to a timely diagnosis and avoid costly and unnecessary rehabilitation procedures. In this case, the interdisciplinary collaboration between physiotherapist and neurosurgeon was crucial in guiding the patient towards recovery.
Collapse
Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Angelo Scrimitore
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Denis Pennella
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Francesco Bruno
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Raffaello Pellegrino
- Antalgic Mini-Invasive and Rehab-Outpatients Unit, Department of Medicine and Science of Aging, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy
- Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano, Switzerland
| | - Filippo Maselli
- Department of Human Neurosciences, University of Rome “Sapienza”, 00185 Rome, Italy
- Sovrintendenza Sanitaria Regionale Puglia INAIL, 70121 Bari, Italy
| | - Francesco Lena
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
- Department of Neurology, IRCCS INM Neuromed, 86077 Pozzilli, Italy
| | - Giuseppe Giovannico
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Goraya GS, Singhal S, Paul BS, Paul G. Aggressive Vertebral Hemangioma: The Mystery of Spastic Legs Unveiled by a Purple Shoulder. Cureus 2022; 14:e21568. [PMID: 35228927 PMCID: PMC8873442 DOI: 10.7759/cureus.21568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 11/07/2022] Open
Abstract
Vertebral hemangiomas (VHs) are benign vascular tumors that develop from the endoderm of blood vessels, although their exact pathogenesis is poorly understood. Most hemangiomas are small, about a third are multiple in number, and a very small number of these hemangiomas cause symptoms. Even more rare are aggressive VHs, which comprise a small number of all VHs, and are associated with expansion and extraosseous extension into the paraspinal and epidural spaces. Management of aggressive VHs involve pre-op embolization, spinal surgery, and reconstruction. Pain management, physical rehabilitation, and close neurological follow-up are imperative to near-total recovery. Aggressive VHs are most commonly seen in the thoracic region but may rarely involve a large number of vertebrae. Cutaneous hemangiomas, when seen along with VHs, are often metameric. We present a rare and challenging case of compressive myelopathy and a large cutaneous hemangioma or a "purple shoulder", found during an exam in a young male. He was found to have an extensive VH extending through 13 vertebral levels (C7 to D12), non-metameric to the cutaneous lesion. A thorough physical examination and evaluation along with prompt surgical treatment were the cornerstone of treatment and prevention of permanent neurological deficits.
Collapse
|
24
|
Oguzoglu AS, Senol N, Göksel HM. Radiofrequency ablation may improve the beneficial results of vertebroplasty for vertebral hemangiomas: analysis of 46 patients. Neurol Res 2021; 44:91-96. [PMID: 34315351 DOI: 10.1080/01616412.2021.1956291] [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: 12/25/2022]
Abstract
OBJECTIVES To evaluate the effect of vertebroplasty (VP) alone or combined therapy of radiofrequency ablation (RFA) with vertebroplasty on pain relief with visual analog scale (VAS) and Oswestry Disability Index (ODI) scores in vertebral hemangiomas. METHODS Forty-six patients with hemangiomas were evaluated retrospectively: 20 males and 26 females were included. In group 1 (n = 25) only VP was performed, while RFA+VP were performed in the same treatment session in group 2 (n = 21). Radiological diagnosis was performed with X-ray, CT-scan and MRI images in all patients. The intensity of pain was assessed with the VAS together with the assesment of life quality with the ODI. The assesments were performed before, at first day, at first month and 6 months after treatment. RESULTS There was no significant difference between mean preprocedural VAS and ODI scores, but a significant decrease was seen in postprocedural VAS and ODI scores between group 1 and 2, when compared with the preprocedural values. Although lack of a statistically significant difference in long term results, mean VAS score was 3.7 for group 1, while it was 1.8 for group 2, and the mean ODI score was 38 for group 1, and 22.48 for group 2 at 6th month assesment. DISCUSSION Although minimally invasive percutaneous techniques are indicated as other modalities are ineffective or contraindicated, combining RFA with vertebral augmentation provide prevention of mechanical loading pain, and prevention of somatic pain in patients with spinal hemangiomas.
Collapse
Affiliation(s)
- Ali Serdar Oguzoglu
- Department of Neurosurgery, Faculty of Medicine, Suleyman Demirel Univercity, Isparta, Turkey
| | - Nilgun Senol
- Department of Neurosurgery, Faculty of Medicine, Suleyman Demirel Univercity, Isparta, Turkey
| | - Hakan Murat Göksel
- Department of Neurosurgery, Faculty of Medicine, Suleyman Demirel Univercity, Isparta, Turkey
| |
Collapse
|
25
|
Xu D, Kong M, Zhu K, Han X, Zhang W, Zeng X, Zhou C, Ma X. Clinical evaluation of preoperative embolization, vertebroplasty, and decompression in the treatment of aggressive vertebral hemangiomas. J Orthop Surg (Hong Kong) 2021; 29:2309499021993997. [PMID: 33641539 DOI: 10.1177/2309499021993997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of preoperative embolization and vertebroplasty in the treatment of aggressive hemangioma. METHODS A retrospective clinical review of patients diagnosed with aggressive vertebral hemangiomas was conducted. All the patients were assigned to three groups according to the treatment strategies: patients in Group A underwent embolization and decompression with internal fixation, patients in Group B underwent vertebroplasty and decompression with internal fixation, patients in Group C received all three treatments. Clinical indexes were compared within three groups. RESULTS There were 16 patients received embolization and decompression (Group A), 19 patients underwent decompression with vertebroplasty (Group B) and 16 patients in Group C. The operative duration of patients in group A (198.33 ± 38.43 min) were less than another two groups (p = 0.001). The intraoperative blood loss of patients in group C was 713.33 ± 165.13 mL, which was significantly less than group A and group B (p = 0.045). Patients in group C exhibited the lowest volume of drainage on POD 1 (178.33 ± 66.76 mL), which showed significant difference compared with group A (368.33 ± 191.15 mL, p = 0.01). There was no significant difference of preoperative and postoperative VAS and JOA score among three groups, as well as drainage on POD 2, total volume and hospital duration. CONCLUSION Both embolization and vertebroplasty are efficient and safe measures to reduce blood loss in the surgical treatment of aggressive vertebral hemangiomas, combination of all three methods is also competent.
Collapse
Affiliation(s)
- Derong Xu
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.,Derong Xu and Meng Kong are co-first authors
| | - Meng Kong
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.,Derong Xu and Meng Kong are co-first authors
| | - Kai Zhu
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xing Han
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Wenwei Zhang
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xiangxu Zeng
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Chuanli Zhou
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xuexiao Ma
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| |
Collapse
|
26
|
Brunette-Clément T, Weil AG, Shedid D. Total en bloc spondylectomy of locally aggressive vertebral hemangioma in a pediatric patient. Childs Nerv Syst 2021; 37:2115-2120. [PMID: 33130918 DOI: 10.1007/s00381-020-04954-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Vertebral hemangiomas are benign, highly vascular spinal lesions that are extremely rare in the pediatric population. We report a pediatric case of symptomatic vertebral hemangioma treated with total en bloc spondylectomy. Our objective is to demonstrate that en bloc spondylectomy is feasible and addresses some pitfalls of traditional total tumor resection. METHODS Our patient presented with bilateral lower limb and perineal paresthesia, paraparesis, as well as urinary retention. Locally aggressive vertebral hemangioma was the presumed diagnosis following imaging. The patient received partial angioembolization to reduce the vascularization of the lesion then underwent total en bloc spondylectomy of T8 under intraoperative neuromonitoring. The intervention was well tolerated. RESULTS Postoperative course was marked by clinical improvement and only transient, treatable complications. On 1-year follow-up, the patient is neurologically intact, and imaging reveals adequate position of hardware, good alignment, and no tumor recurrence. CONCLUSION Total en bloc spondylectomy is a feasible procedure in pediatric patients. It reduces local recurrence through reduction of tumor cell contamination and residual tumor and thus may avoid postoperative radiotherapy in select cases. It may also enhance functional neurological recovery by allowing circumferential decompression and increased spinal cord blood flow.
Collapse
Affiliation(s)
- Tristan Brunette-Clément
- Division of Neurosurgery, Sainte-Justine University Hospital Center, 3175, chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - Alexander G Weil
- Division of Neurosurgery, Sainte-Justine University Hospital Center, 3175, chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.
| | - Daniel Shedid
- Division of Neurosurgery, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| |
Collapse
|
27
|
D'Ortenzio R, Tolhurst S, Harvey M, Ghag R, Heran MK. The CT guided transoral approach: A biopsy technique for a poorly differentiated chordoma in a 5 year old. J Radiol Case Rep 2021; 15:1-8. [PMID: 34267865 DOI: 10.3941/jrcr.v15i3.4208] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Mass lesions presenting at the craniocervical junction often present a unique challenge due to the complex anatomic arrangement limiting access for tissue diagnosis. The transoral approach has predominantly been used for percutaneous vertebroplasty of high cervical vertebrae with limited literature describing image guided biopsy for bony lesions in this region in the pediatric patient. We describe a technique of computed tomography guided transoral biopsy of a poorly differentiated chordoma located at the C1-C2 level in a 5-year-old child, and review this diagnosis.
Collapse
Affiliation(s)
- Robert D'Ortenzio
- Department of Radiology, Vancouver General Hospital, Vancouver, Canada
| | - Stefano Tolhurst
- Department of Radiology, Vancouver General Hospital, Vancouver, Canada
| | - Melissa Harvey
- Department of Pediatrics, BC Children's Hospital, Vancouver, Canada
| | - Ravi Ghag
- Department of Orthopaedics, BC Children's Hospital, Vancouver, Canada
| | - Manraj Ks Heran
- Department of Radiology, BC Children's Hospital, Vancouver, Canada
| |
Collapse
|
28
|
Shamhoot EA, Balaha AM, Ganna AA. Role of Combined Vertebroplasty and Spinal Decompression in the Management of Aggressive Vertebral Hemangiomas. Asian J Neurosurg 2021; 15:919-925. [PMID: 33708663 PMCID: PMC7869295 DOI: 10.4103/ajns.ajns_291_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/04/2020] [Accepted: 09/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background: There are different surgical modalities designed to manage aggressive vertebral hemangioma (VH) that causes neurological symptoms. The selection of the best approach is still controversial. It is crucial to safely achieve neurological recovery with the elimination of the risk of recurrence. The combined use of surgical decompression and vertebroplasty is one of the surgical modalities that are used to manage these cases. Patients and Methods: From January 2012 to January 2019, nine patients with aggressive VH were retrospectively included in the study. All of them were operated upon using combined surgical decompression and vertebroplasty. We evaluated all the patients preoperatively, immediate postoperative, 1 month, and 12 months later. Clinical and radiological outcomes were assessed. Results: Affected spinal levels were dorsal in six cases and lumbar in three cases. There was no postoperative worsening of the preoperative neurological status. For the cases presented with sciatica, the mean VAS score has dropped from 8.33 preoperatively to 2.67 postoperatively. One month later, all of them are free from the radicular pain. For the cases presented with myelopathy, they regain their motor power in both lower limbs over a period of 4 weeks with a mean Nurick grade of 1.17. The postoperative radiological studies revealed near total occlusion of the VH with the maintenance of the vertebral body height. No clinical or radiological signs of spinal instability or recurrence are observed over the period of follow-up. Conclusions: The combined use of surgical decompression and vertebroplasty is considered a safe and effective modality in the management of aggressive VHs.
Collapse
Affiliation(s)
| | | | - Ahmed Atef Ganna
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| |
Collapse
|
29
|
|
30
|
Gupta AK, Phukan P, Bodhey N. Percutaneous vertebroplasty for the treatment of symptomatic vertebral hemangioma with long-term follow-up. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
31
|
Roscop C, Gariel F, Kieser DC, Bouyer B, Gille O, Marnat G, Berge J. Doughnut vertebroplasty for circumferential aggressive vertebral hemangiomas. J Neurointerv Surg 2021; 14:neurintsurg-2020-016785. [PMID: 33632885 DOI: 10.1136/neurintsurg-2020-016785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND To assess the feasibility, safety and efficacy of a percutaneous doughnut vertebroplasty of circumferential aggressive vertebral hemangiomas (VHs). METHODS We retrospectively reviewed our prospectively collected database of patients with VHs treated with vertebroplasty between January 2009 and January 2018. Patient demographics, clinical presentations and procedural details were recorded. All patients underwent preoperative computed tomography (CT) and magnetic resonance imaging (MRI). All vertebroplasties were performed under conscious sedation in the prone position, predominantly using biplane fluoroscopic guidance. A clinical and imaging evaluation (early CT scan and MRI) as well as a final follow-up clinical assessment was performed. RESULTS Twenty-two patients with aggressive VHs who underwent circumferential vertebroplasty with cementation of the entire vertebral body and at least one posterior hemi-arch were included (six males, mean age 53 years). At 3 months follow-up, nine patients (41%) had complete, 11 (50%) had partial and two (9%) had no resolution of pain. Nine of 14 patients had a decrease in venous swelling on MRI. No complications were observed. Five patients (23%) underwent adjunctive surgery within 1 year for persistence or worsening of neurological symptoms. Clinical and radiographic improvements were maintained to final follow-up. CONCLUSIONS Doughnut vertebroplasty offers a mini-invasive, safe and effective treatment of aggressive circumferential VHs. This technique improves pain in over 90% of patients as well as a reduction in radicular and neurological symptoms associated with a tendency to regression of the compressive epidural venous component of these lesions.
Collapse
Affiliation(s)
- Cecile Roscop
- The Spine Institute, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Florent Gariel
- Interventional Neuroradiology, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - David Christopher Kieser
- Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Benjamin Bouyer
- The Spine Institute, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Olivier Gille
- The Spine Institute, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Gaultier Marnat
- Interventional Neuroradiology, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France.,Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Jerome Berge
- Interventional Neuroradiology, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| |
Collapse
|
32
|
Chopra H, Hoffman H, Richardson TE, Galgano MA. Surgical management of symptomatic vertebral hemangiomas: A case report and literature review. Surg Neurol Int 2021; 12:56. [PMID: 33654559 PMCID: PMC7911040 DOI: 10.25259/sni_752_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/18/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Vertebral hemangiomas (VHs) are common benign tumors that only rarely become symptomatic. There is a paucity of data regarding their surgical management and outcomes. Here, we reported a case involving an aggressive cervical VH, discussed its surgical management and outcomes, and reviewed the literature. Methods: We assessed the clinical, radiological, and surgical outcomes for a patient with an aggressive cervical VH. We also performed a systematic review of the literature according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to describe surgical outcomes for symptomatic VH. Results: A total of 154 studies including 535 patients with VH were included in the study. The majority of patients were female (62.8%), the average age was 43 years, and the thoracic spine was most commonly involved (80.6%). Utilizing Odom’s criteria, outcomes were excellent in 81.7% (95% CI 73.2–90.2) of cases. For those presenting with myelopathy (P = 0.045) or focal neurological deficits (P = 0.018), outcomes were less likely to be excellent. Preoperative embolization was not associated with excellent outcome (P = 0.328). Conclusion: Surgical outcomes for VH are predominantly favorable, but aggressive VHs have the potential to cause significant residual postoperative neurological morbidity.
Collapse
Affiliation(s)
- Harman Chopra
- Department of Neurosurgery, SUNY Upstate, Syracuse, New York, United States
| | - Haydn Hoffman
- Department of Neurosurgery, SUNY Upstate, Syracuse, New York, United States
| | | | - Michael A Galgano
- Department of Neurosurgery, SUNY Upstate, Syracuse, New York, United States
| |
Collapse
|
33
|
Papadakos D, Boulieris S, Theofanopoulos A, Fermeli D, Constantoyannis C. Tubular laminectomy and percutaneous vertebroplasty for aggressive vertebral hemangioma. Surg Neurol Int 2021; 12:27. [PMID: 33598343 PMCID: PMC7881512 DOI: 10.25259/sni_888_2020] [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: 12/08/2020] [Accepted: 12/23/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Vertebral hemangiomas (VH) are the most common benign vascular neoplasms of the spine. Aggressive VH (AVH) may become symptomatic due to soft-tissue expansion/extraosseous extension into the paraspinal and/or epidural spaces. There are several options for treating painful AVH, including radiotherapy and/or open surgery. Case Description: A 59-year-old male presented with a 2-year history of intermittent back pain and progressive thoracic myelopathy in the past 2 months. MRI revealed a T9 level lesion, with high-intensity signal on both T1 and T2 images and an extraosseous component with significant cord compression. We performed minimally invasive tubular unilateral laminotomy for bilateral decompression of the thoracic spine at the T9 level, followed by bilateral percutaneous vertebroplasty with biopsy. Postoperatively, the pain was immediately relieved, and the myelopathy improved. The biopsy confirmed the diagnosis of a VH. Conclusion: Combining minimally invasive techniques consisting of tubular laminectomy and percutaneous vertebroplasty are safe and effective ways for treating AVHs.
Collapse
Affiliation(s)
- Dimitrios Papadakos
- Department of Neurosurgery, University Hospital of Patras, Rio University Hospital, Patras, Achaia, Greece
| | - Spiros Boulieris
- Department of Neurosurgery, University Hospital of Patras, Rio University Hospital, Patras, Achaia, Greece
| | - Andreas Theofanopoulos
- Department of Neurosurgery, University Hospital of Patras, Rio University Hospital, Patras, Achaia, Greece
| | - Dionysia Fermeli
- Department of Neurosurgery, University Hospital of Patras, Rio University Hospital, Patras, Achaia, Greece
| | | |
Collapse
|
34
|
Singh PK, Chandra SP, Agrawal M, Sawarkar D, Kumar R, Kumar A, Verma S, Kale SS. Long-Term Outcome of Surgical Management in Symptomatic Pediatric Vertebral Hemangiomas Presenting With Myelopathy. Neurosurgery 2020; 87:1240-1251. [PMID: 32629465 DOI: 10.1093/neuros/nyaa273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 04/15/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vertebral hemangiomas are benign, highly vascular lesions of the vertebra, rarely seen in the pediatric age group. OBJECTIVE To analyze the long-term (>3 yr) outcome of patients of pediatric vertebral hemangioma presenting with myelopathy and to describe our surgical strategy to treat such cases. METHODS All patients up to 18 yr of age with a symptomatic vertebral hemangioma treated at our hospital from May 2003 to August 2016, with at least 3-yr follow-up were included. Functional clinical outcomes were measured using American Spinal Injury Association (ASIA) score. RESULTS There were 7 male and 7 female patients. All hemangiomas were located in the thoracic spine with single-level involvement. Upper thoracic spine involvement was more common (12 cases: 85.71%) than lower thoracic spine involvement (2 cases: 14.29%). All patients had features of myelopathy. The mean age was 14.57 yr, ranging from 10 to 18 yr. The mean follow-up was 62.21 mo, ranging from 36 to 90 mo. All patients had improvement in motor strength of both lower limbs postoperatively. Local pain, which was present in 1 patient, resolved, and the bladder symptoms present in 5 patients also resolved. CONCLUSION Our experience in treating symptomatic pediatric vertebral hemangiomas, along with the long-term follow-up data, suggests that good postoperative results can be achieved with minimal complications in carefully selected patients.
Collapse
Affiliation(s)
- Pankaj K Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sarat P Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Dattaraj Sawarkar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajender Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amandeep Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Satish Verma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
35
|
Agbotsou KI, Kombate D, Adigo AMY, Apétsè K, Beschet A, Chan V. Hémangiome vertébral neuro-agressif de révélation tardive: cas cliniqueA clinical case of late-onset aggressive vertebral hemangioma with neurological signs. Pan Afr Med J 2020; 37:218. [PMID: 33520057 PMCID: PMC7821802 DOI: 10.11604/pamj.2020.37.218.24313] [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: 06/14/2020] [Accepted: 07/02/2020] [Indexed: 11/23/2022] Open
Abstract
Résumé Dans la majorité des cas asymptomatiques, les hémangiomes vertébraux peuvent être, dans de rares cas, symptomatiques avec des manifestations cliniques purement neurologiques. S´ils sont fréquemment observés chez un sujet adulte jeune, ils peuvent exceptionnellement être observés chez un sujet âgé. Nous rapportons un cas d´hémangiome vertébral neuro-agressif de révélation tardive traité par une chirurgie décompressive, une sclérothérapie, une cimentoplastie et suivi d´une évolution favorable. English abstract In the majority of asymptomatic cases, vertebral hemangiomas can be, in rare cases, symptomatic with purely neurological clinical manifestations. They commonly occur in young adults, exceptionally in elderly subjects. We here report a case of late onset aggressive vertebral hemangioma with neurological signs treated with decompressive surgery, sclerotherapy and cementoplasty, with favorable outcome.
Collapse
Affiliation(s)
- Komi Ignéza Agbotsou
- Service de Neurologie du Centre Hospitalier de Valence, Valence, France.,Service de Neurologie du Centre Hospitalier Universitaire Campus, Lomé, Togo
| | - Damelan Kombate
- Service de Neurologie du Centre Hospitalier Universitaire Campus, Lomé, Togo
| | | | - Kossivi Apétsè
- Service de Neurologie du Centre Hospitalier Universitaire Campus, Lomé, Togo
| | - Albert Beschet
- Service de Neurologie du Centre Hospitalier de Valence, Valence, France
| | - Victor Chan
- Service de Neurologie du Centre Hospitalier de Valence, Valence, France
| |
Collapse
|
36
|
Kim YW, Taihi L, Viry F, Bossard P, Polivka M, Bousson V. Aggressive vertebral hemangioma: a post-bioptic finding, the gas web sign-report of two cases. BJR Case Rep 2020; 6:20190091. [PMID: 33029370 PMCID: PMC7527010 DOI: 10.1259/bjrcr.20190091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 01/18/2020] [Accepted: 01/27/2020] [Indexed: 12/02/2022] Open
Abstract
Vertebral hemangiomas are relatively frequent among tumors of the spine. Most of them are asymptomatic and the diagnosis is usually made based solely on imaging. However, although rare, some hemangiomas with atypical imaging features (aggressive hemangiomas) can pose a diagnostic challenge. Clinically, these patients present with neurological symptoms. In imaging, aggressive hemangiomas appear as lesions with significant osseous expansion or extraosseous extension, mimicking the appearance of other tumors, such as metastasis or plasmacytoma. In such cases, a biopsy is often required to obtain a histopathological diagnosis in order to rule out the differential diagnoses mentioned above. We report on two cases of aggressive hemangiomas whose diagnosis remained uncertain until the pathology analysis. On CT-scan control immediately after biopsy, we have been surprised to observe the formation of gas bubbles inside the biopsied lesion, spreading over almost the whole vertebra. This gas web sign may support its liquid-filled spaces composition and its benign nature. Our goal was to highlight this finding and its usefulness.
Collapse
Affiliation(s)
- Young-Wouk Kim
- Service d'Imagerie Ostéo-Articulaire, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France
| | | | - Flore Viry
- Service d'Imagerie Ostéo-Articulaire, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France
| | - Philippe Bossard
- Service d'Imagerie Ostéo-Articulaire, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France
| | - Marc Polivka
- Service d'Anatomopathologie, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France
| | | |
Collapse
|
37
|
Cazzato RL, Garnon J, De Marini P, Auloge P, Dalili D, Koch G, Antoni D, Barthelemy P, Kurtz JE, Malouf G, Feydy A, Charles YP, Gangi A. French Multidisciplinary Approach for the Treatment of MSK Tumors. Semin Musculoskelet Radiol 2020; 24:310-322. [DOI: 10.1055/s-0040-1710052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractSeveral interventional treatments have recently been integrated into the therapeutic armamentarium available for the treatment of bone tumors. In some scenarios (e.g., osteoid osteoma), interventional treatments represent the sole and definitive applied treatment. Due to the absence of widely shared protocols and the complex multivariate scenarios underlying the clinical presentation of the remaining bone tumors including metastases, therapeutic strategies derived from a multidisciplinary tumor board are essential to provide effective treatments tailored to each patient. In the present review, we present the multidisciplinary therapeutic strategies commonly adopted for the most frequent bone tumors.
Collapse
Affiliation(s)
- Roberto Luigi Cazzato
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julien Garnon
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierre De Marini
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierre Auloge
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Danoob Dalili
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Nuffield Orthopaedic Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Guillaume Koch
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Delphine Antoni
- Service de Radiothérapie, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Philippe Barthelemy
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Jean Emmanuel Kurtz
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Gabriel Malouf
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Antoine Feydy
- Service de Radiologie, Hôpital Cochin, APHP, Université Paris V, Paris, France
| | - Yan-Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| |
Collapse
|
38
|
Ashwinkumar Vyas J, Tallapragada K, Turchini J, Damodaran O. Rare extraforaminal thoracic capillary haemangioma mimicking a schwannoma: a case report. ANZ J Surg 2020; 91:E307-E309. [PMID: 32926766 DOI: 10.1111/ans.16326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Jayshil Ashwinkumar Vyas
- Department of Neurosurgery, Concord Repatriation and General Hospital, Sydney, New South Wales, Australia
| | - Krishna Tallapragada
- Department of Neurosurgery, Concord Repatriation and General Hospital, Sydney, New South Wales, Australia
| | - John Turchini
- Anatomical Pathology, Douglass Hanly Moir Pathology, Sydney, New South Wales, Australia.,Discipline of Pathology, MQ Health, Macquarie University, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Omprakash Damodaran
- Department of Neurosurgery, Concord Repatriation and General Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
39
|
Concurrent Spindle Cell Hemangioma and Schwannoma of the Jugular Foramina. Otol Neurotol 2020; 41:e1276-e1278. [PMID: 32810020 DOI: 10.1097/mao.0000000000002803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
40
|
Qiu B, Joo P, Ajabnoor R, Boyce B, Mesfin A. Surgical management of aggressive hemangiomas of the spine. J Clin Neurosci 2020; 78:67-72. [PMID: 32620473 DOI: 10.1016/j.jocn.2020.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 04/30/2020] [Accepted: 06/09/2020] [Indexed: 12/25/2022]
Abstract
Our objective is to describe the surgical management and outcomes following surgical intervention for aggressive spine hemangiomas. Patients from 2005 to 2018 with an aggressive hemangioma of the cervical, thoracic, lumbar spine and sacrum treated surgically at a tertiary referral academic medical center were included in this study. The hospital pathology department database was used to identify patients with a diagnosis of aggressive hemangioma. Patient demographics, medical history, operative procedure, adjunct treatment, early and late complications, and recurrence were analyzed using the Fischer exact test with significance set at p < 0.05 Ten patients met inclusion criteria for the study. The average follow up was 11 months. Eight out of ten patients had aggressive hemangioma of the thoracic spine. Seven of the ten patients presented with back or leg pain. The most common surgery was laminectomy at the site of the lesion (70%). 40% of patients underwent a spinal fusion, with two of these patients receiving concurrent intra-operative vertebroplasty. Three patients underwent post-operative radiation therapy. Five complications were noted among three individuals. There were three perioperative complications, deep venous thrombosis, renal insufficiency, one surgical site infection, and two postoperative complications, both revisions. There were no recurrences. Surgical intervention for aggressive spine hemangiomas is an effective treatment with relatively low complication and recurrence rates.
Collapse
Affiliation(s)
- Bowen Qiu
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Peter Joo
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Rana Ajabnoor
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Brendan Boyce
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Addisu Mesfin
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States.
| |
Collapse
|
41
|
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.
Collapse
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
| |
Collapse
|
42
|
Corniola MV, Schonauer C, Bernava G, Machi P, Yilmaz H, Lemée JM, Tessitore E. Thoracic aggressive vertebral hemangiomas: multidisciplinary management in a hybrid room. 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 2020; 29:3179-3186. [PMID: 32277334 DOI: 10.1007/s00586-020-06404-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/25/2020] [Accepted: 03/30/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Vertebral hemangiomas (VH) account for 2-3% of all spinal tumors. The majority is incidentally found on radiographic studies: 1% present with pain and/or neurologic deficits. We report our experience with the multidisciplinary management of aggressive symptomatic thoracic VH by concomitant intraoperative sclerotization with sodium tetradecyl sulfate (STS), vertebroplasty, posterior decompression (with/without fusion) and surgical resection in a hybrid operating room (HR) equipped with a rotational scanner and a radiolucent operating table. METHODS Patients admitted with aggressive spinal VH between 2007 and 2018 were included. Data regarding demographics, presenting symptoms, location of the lesion, preoperative embolization, length of the surgery, estimated blood loss (EBL) as well as follow-up (FU) were retrieved. RESULTS Five patients were included (three females, mean age 65 years; range 59-75). Three patients presented with a myelopathy and two mechanical thoracic pain. All patients underwent a single-stage percutaneous sclerotization and vertebroplasty followed by a surgical decompression associated with epidural intralesional injection of STS and subtotal resection of the epidural lesion. Two patients had preoperative embolization. Mean procedural duration was 338 min (range 210-480 min). Four patients had marginal EBL, one patient had 500 ml EBL. Patients had no evidence of lesion recurrence or progression at the end of the follow-up. CONCLUSIONS The single-stage multimodal management of aggressive symptomatic VH is safe and effective. It allows for a direct intraoperative sclerotherapy combined with maximal tumor resection, resulting in reduced blood loss. The use of STS as a direct intraoperative sclerotizing agent is safe and reliable.
Collapse
Affiliation(s)
- Marco V Corniola
- Spine Unit, Département Des Neurosciences Cliniques, Service de Neurochirurgie, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Claudio Schonauer
- Neurosurgical Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Gianmarco Bernava
- Neuroradiology Unit, Department of Radiology, Geneva University Hospitals, Geneva, Switzerland
| | - Paolo Machi
- Neuroradiology Unit, Department of Radiology, Geneva University Hospitals, Geneva, Switzerland
| | - Hasan Yilmaz
- Neuroradiology Unit, Department of Radiology, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Michel Lemée
- Spine Unit, Département Des Neurosciences Cliniques, Service de Neurochirurgie, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Enrico Tessitore
- Spine Unit, Département Des Neurosciences Cliniques, Service de Neurochirurgie, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| |
Collapse
|
43
|
Surgical Management and Adjuvant Therapy for Patients With Neurological Deficits From Vertebral Hemangiomas: A Meta-Analysis. Spine (Phila Pa 1976) 2020; 45:E99-E110. [PMID: 31365517 DOI: 10.1097/brs.0000000000003181] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVE To understand the benefits and limitations of surgical management and adjuvant therapies for patients presenting with neurological deficits from vertebral hemangiomas (VH). SUMMARY OF BACKGROUND DATA VH is the most common benign spine tumor but rarely causes symptoms. Patients with back pain alone are treated with conservative management (kyphoplasty and radiation therapy), while those with neurological deficits require complex multi-modal treatment plans. METHODS A PubMed literature search for "symptomatic vertebral hemangioma with spinal cord compression" identified 47 articles. From these articles and their references, 19 observational studies on patients who underwent surgery for VH met inclusion criteria. Meta-analyses were performed comparing outcomes of the surgical and adjuvant therapies using Stata13 software. For those with insufficient data for meta-analyses, descriptive analyses of variables were completed. RESULTS One hundred ninety seven surgical cases of VH with neurologic deficits were identified. Surgery provided a complete remission of symptoms in 84% of patients, however 18% of patients had recurrence of hemangioma. Adjuvant interventions included radiation, embolization, and kyphoplasty. Radiation therapy (XRT) was associated with a lower recurrence rate and an increase in minor transient adverse effects. Preoperative embolization performed in 98 patients was associated with improved symptoms, reduced complications, lower recurrence rate, less blood loss, and higher incidence of pathologic vertebral fractures. Meta-analyses did not yield statistically significant results, likely due to the heterogeneity amongst the studies and small sample sizes, but the results compiled together provide insight on potential benefits of preoperative embolization for symptomatic relief and reduced risk of recurrence with XRT that deserves further study. CONCLUSION For patients with neurologic deficits from spinal cord or nerve root compression, surgery provides improvement in symptoms. Recurrence of VH and symptoms refractory to surgery can be further reduced by adjuvant therapies such as embolization, kyphoplasty, and radiation with some unique risks to each therapy. LEVEL OF EVIDENCE 2.
Collapse
|
44
|
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
|
45
|
Ikele I, Katchy A, Ekwedigwe H, Ugwu I, Ahaotu F, Ikele C. Bilateral symmetrical humeral fracture on a background of multiple myeloma and humeral capillary hemangioma. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_132_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
46
|
Rao A, Reddy VS, Parimala MD, Tejal M, Fathima K, Preeti S, Jhawar J, Dharani V, Shruthi T. Sturge–Weber syndrome coexisting with multiple vertebral vascular malformations and hemivertebra with scoliosis and upper limb and ear hypertrophy. Indian J Dermatol Venereol Leprol 2020; 86:187-190. [DOI: 10.4103/ijdvl.ijdvl_445_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
47
|
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.
Collapse
|
48
|
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.
Collapse
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
| |
Collapse
|
49
|
Uehara M, Takahashi J, Kuraishi S, Ikegami S, Futatsugi T, Oba H, Takizawa T, Koiwai K, Otsuki T, Uehara T, Kato H. Effectiveness of postoperative radiation therapy for thoracic spine hemangioma recurrence. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2019. [DOI: 10.1016/j.inat.2019.100560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
50
|
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.
Collapse
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
| |
Collapse
|