Total en bloc spondylectomy of locally aggressive vertebral hemangioma in a pediatric patient (original) (raw)
Related papers
In Vertebral Hemangiomas with Neurological Deficit, Is a Less Extensive Approach Adequate
Asian Spine Journal
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.
A novel surgical technique for aggressive vertebral hemangiomas
Neurocirugia (Asturias, Spain), 2018
Vertebral hemangiomas are relatively common, but those causing spinal cord compression are rare. A 19-year-old male presented with thoracic back pain. The neurologic examination was normal and radiological examinations demonstrated an aggressive vertebral hemangioma centered within the T11 vertebral body. Damaged vertebral bone and soft tissue components of the mass were observed in the epidural space. Surgery was performed using a new technique involving radiofrequency ablation, injection of a hemostatic agent (FLOSEAL, Baxter, USA), and bone autograft placement in the affected vertebral body. There were no complications intra- or postoperatively, and the patient's back pain resolved completely during the postsurgical period. Bleeding is a serious issue in cases of aggressive vertebral hemangioma. This new technique provides improved bleeding control and strengthens the affected vertebra through autograft placement.
Neuroradiology, 2009
Introduction This study aimed to illustrate the validity of the treatment with vertebroplasty (VP) in patients with aggressive or symptomatic vertebral hemangioma (VH) with or without epidural extension. Methods From January 2003 to December 2007, 24 consecutive patients have been treated with VP, for a total of 36 vertebral bodies affected by VH: two cervical, ten dorsal, 24 lumbar. All the patients complained of a pain syndrome resistant to continuous medical medication; four of 24 patients also presented aggressive magnetic resonance features of the vertebral lesion and two patients showed also epidural extension. A unipedicular approach has been performed in 16 patients; a bipedicular approach has been performed in six, while for the cervical spine an anteriorlateral approach with manual dislocation of the carotid axis has always been performed. Bone biopsy was never done. All procedures have been carried out with local anesthesia, except for the treatment of the cervical hemangiomas which has always been performed under general anesthesia. Four vertebral bodies in the same session have been treated in one case. Results Results have been evaluated with the visual analog scale and the Oswestry Disability Index methods. In all the patients, in the following 24-72 h, a successful outcome has been observed with a complete resolution of pain symptom. Extravertebral vascular or discal cement leakage has been observed in four patients, without any onset of clinical radicular syndrome due to epidural diffusion. Clinical and radiological follow-up until 4 years has been performed in 12 patients and it showed stability of the treatment and absence of pain. Conclusions Percutaneous treatment with VP for aggressive and symptomatic vertebral hemangiomas even with epidural extension is a valuable, mini-invasive, and quick method that allows a complete and enduring resolution of the painful vertebral symptoms without findings of fracture of a vertebral body adjacent or distant to the one treated.
A minimally invasive vertebral hemangioma
JBR-BTR : organe de la Société royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR)
We describe a very unusual vertebral hemangioma presenting with a mixture of aggressive-like pattern (epidural extension, T1 hyposignal) and quiescent, inactive lesion (fatty infiltration), in association with a spiculated calcified epidural component.This paper emphasizes that CT and/or MR findings are accurate enough to make formal assessment of vertebral hemangioma, preventing patient's anguish and moreover unnecessary treatment. Furthermore this attractive case proposes a poorly known characteristic of vertebral hemangioma which is usually encountered and described only in skull hemangiomas.
Tubular laminectomy and percutaneous vertebroplasty for aggressive vertebral hemangioma
Surgical Neurology International, 2021
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 tec...
Journal of Clinical Neuroscience, 2011
Vertebral hemangiomas (VHs) are frequently asymptomatic lesions found incidentally during investigations for other spinal problems. Symptomatic VHs are less common, and there are few reports of compressive VHs in the literature. VHs with aggressive behavior present with low signal intensity on T1-weighted and high signal intensity on T2-weighted MRI. We present a case series of four patients with compressive VH, all of whom were neurologically compromised. Each of the four patients underwent preoperative arterial embolization followed by surgical treatment of their VHs. All patients recovered normal motor function after surgery. At follow-up (average 53 months), one patient had a recurrent tumor requiring reoperation and radiotherapy. Although it is rare, aggressive VH can be a devastating condition. Total surgical resection or subtotal resection with radiotherapy may be warranted.
Thoracic spinal cord compression by an atypical aggressive vertebral hemangioma – A case report
Nepal Journal of Neuroscience
Vertebral hemangiomas are benign vascular lesions of bone , composed of multiple thin-walled vessels surrounded by fat infiltrating the medullary cavity between bony trabeculae.(1) Hemangiomas account for around 2-3% of all spinal tumors and only 0.9-1.2% of these are symptomatic. Surgery is recommended for lesions if they progress rapidly and cause neurological deficits. 47 years old female patient presented with bilateral lower limb weakness due to an aggressive atypical vertebral body hemangioma at D7 level. Patient underwent pre-op embolisation with surgical decompression and stabilization. Neurological recovery was almost complete over a period of 2 months.
Symptomatic vertebral hemangiomas- results of treatment with radiotherapy
Indian Journal of Radiology and Imaging, 2006
Objectives : Vertebral hemangiomas are benign vascular lesions occurring in spine. Though vertebral hemangiomas are frequently seen, they are rarely symptomatic. Pain is the commonest symptom. There is no agreement on single treatment modality for symptomatic lesions. Surgery, intralesional injection of absolute alcohol, methyl methacrylate injection are few methods used to treat them. Radiotherapy has been shown effective in many studies in terms of pain relief and at times in cord compression too. Results of radiotherapy in symptomatic vertebral hemangiomas treated in our centre are analyzed. Materials and methods: Six patients with symptomatic vertebral hemangiomas were treated with external radiotherapy to a dose of 36-40 Gy. Four patients had only pain as their symptom. Two patients had additional neurological deficits with paraperesis at presentation. Result in terms of pain relief was assessed at the end of RT and during follow up. Median follow up was four and half months. R...
Percutaneous vertebroplasty in painful refractory vertebral hemangiomas
Indian Journal of Orthopaedics, 2014
Background: Painful vertebral hemangiomas are often inadequately managed medically. We evaluated the outcome of percutaneous vertebroplasty (PVP) in the treatment of painful vertebral hemangiomas refractory to medical management. Materials and Methods: 14 patients (four thoracic and ten lumbar vertebra) with painful vertebral hemangiomas presenting with severe back pain for more than 6 months not responding to medical therapy were treated by vertebroplasty. Cross sectional imaging of the spine with magnetic resonance was done. Blood investigations were done to exclude coagulopathy excluded. PVP was performed under local anesthesia. Results: The pain intensity numeric rating scale (PI-NRS-11) of these patients was in the range of 7-10 (Severe Pain). After vertebroplasty 8 patients were completely free of pain (PI NRS Score 0) while 6 were significantly relieved (PI-NRS Score 1-3). No complications were observed. Two patients with associated radicular pain had good pain relief following PVP. No recurrence was found during 36 months of postoperative followup. Conclusion: PVP is a safe and effective procedure in patients with painful vertebral hemangiomas refractory to medical management.