Blood Loss in Surgery for Aggressive Vertebral Haemangioma with and without Embolisation

Robinson, Yohan; Sheta, Reda Ali; Salci, Konstantin; Willander, Johan

doi:10.4184/asj.2015.9.3.483

Cited by 39 publications

(22 citation statements)

References 26 publications

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“…This study found that in the group that received preoperative embolization, blood loss was significantly less than in the group that did not (980 vs 1629 ml, respectively). 60 Cotten et al 15 reported that preoperative embolization can be used in combination with vertebroplasty to even further reduce blood loss during surgery.…”

Section: Endovascular Embolizationmentioning

confidence: 99%

Surgical treatment of aggressive vertebral hemangiomas

Vasudeva

John

Groff

2016

FOC

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OBJECTIVE Vertebral hemangiomas are common tumors that are benign and generally asymptomatic. Occasionally these lesions can exhibit aggressive features such as bony expansion and erosion into the epidural space resulting in neurological symptoms. Surgery is often recommended in these cases, especially if symptoms are severe or rapidly progressive. Some surgeons perform decompression alone, others perform gross-total resection, while others perform en bloc resection. Radiation, embolization, vertebroplasty, and ethanol injection have also been used in combination with surgery. Despite the variety of available treatment options, the optimal management strategy is unclear because aggressive vertebral hemangiomas are uncommon lesions, making it difficult to perform large trials. For this reason, the authors chose instead to report their institutional experience along with a comprehensive review of the literature. METHODS A departmental database was searched for patients with a pathological diagnosis of “hemangioma” between 2008 and 2015. Medical records were reviewed to identify patients with aggressive vertebral hemangiomas, and these cases were reviewed in detail. RESULTS Five patients were identified who underwent surgery for treatment of aggressive vertebral hemangiomas during the specified time period. There were 2 lumbar and 3 thoracic lesions. One patient underwent en bloc spondylectomy, 2 patients had piecemeal gross-total resection, and the remaining 2 had subtotal tumor resection. Intraoperative vertebroplasty was used in 3 cases to augment the anterior column or to obliterate residual tumor. Adjuvant radiation was used in 1 case where there was residual tumor as well. The patient who underwent en bloc spondylectomy experienced several postoperative complications requiring additional medical care and reoperation. At an average follow-up of 31 months (range 3–65 months), no patient had any recurrence of disease and all were clinically asymptomatic, except the patient who underwent en bloc resection who continued to have back pain. CONCLUSIONS Gross-total resection or subtotal resection in combination with vertebroplasty or adjuvant radiation therapy to treat residual tumor seems sufficient in the treatment of aggressive vertebral hemangiomas. En bloc resection appears to provide a similar oncological benefit, but it carries higher morbidity to the patient.

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Section: Endovascular Embolizationmentioning

confidence: 99%

Surgical treatment of aggressive vertebral hemangiomas

Vasudeva

John

Groff

2016

FOC

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“…In accordance with the principles of biomechanics concerning vertebral fractures [23] , [24] , this clinical case did not require any posterior stabilization system with screws and rods, because the articular processes were spared. Pre-operative embolization may provide reduction of bleeding risks in selected cases [25] , [26] , but in our case embolization was not performed because the specific clinical picture urged rapid treatment and the our surgical approach (laminectomy with lesion removal) exposed to a lower risk of bleeding compared to anterior corpectomy. After the partial lesion removal, radiation therapy was recommended for this patient, because it has been demonstrated to be able to reduce local recurrence, but the patient did not undergo the procedure.…”

Section: Discussionmentioning

confidence: 95%

Surgical treatment of aggressive vertebral hemangioma causing progressive paraparesis

Dobran

Mancini

Nasi

et al. 2018

Annals of Medicine &Amp; Surgery

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Vertebral hemangioma is a benign vascular lesion that may onset with neurologic symptoms due to spinal cord compression by epidural extension. Surgical procedure, embolization and radiotherapy are the gold standard for the treatment of this disease. We present a case of a 84 years old woman admitted at our department with worsening paraparesis and urinary retention. Her magnetic resonance images (MRI) showed a lesion involving both anterior and posterior vertebral element of D5, with extension into epidural space and spinal cord compression. The patient was operated for laminectomy and epidural lesion removal. Histological examination confirmed the diagnosis of cavernous hemangioma.

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“…In this study, we performed preoperative embolization for all patients undergoing S3 hemangioma surgery to reduce intraoperative blood loss. Robinson et al [22] compared the intraoperative blood loss of patients who underwent preoperative embolization with that of those who did not undergo preoperative embolization and found that preoperative embolization significantly reduced intraoperative blood loss. Other additional factors, including anesthesia, surgical skill, and patient coagulation, might also cause intraoperative blood loss.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative injection of absorbable gelatin sponge (AGS) mixed with cement followed by spinal decompression to treat elderly with vertebral hemangiomas

Lan

Huang

2020

BMC Musculoskelet Disord

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Background: Elderly patients with vertebral hemangiomas are rare and might require surgery. Thus, the choice of surgery for these lesions remains controversial because of the rarity of these lesions. This study aimed to analyze the clinical efficacy of the intraoperative injection of absorbable gelatin sponge mixed with cement followed by spinal decompression to treat the elderly with typical vertebral hemangiomas. The risk factors for hemangioma recurrence were investigated through a literature review. Methods: We retrospectively analyzed 13 patients with typical aggressive hemangiomas between January 2009 and January 2016. Of these patients, 7 were treated with spinal decompression combined with intraoperative vertebroplasty (Group A), and 6 patients were treated with decompression with intraoperative vertebroplasty and absorbable gelatin sponge (Group B). The general data and perioperative data of the patients were compared. Patients were followed up for at least 3 years, and postoperative complications and recurrence rates were recorded and compared. Results: All patients had typical aggressive hemangiomas. The average age of all patients was 64.4 ± 3.3 years. The preoperative data did not differ significantly between the two groups (P > 0.05). The blood loss of groups A and B was 707.1 ± 109.7 ml and 416.7 ± 103.3 ml, respectively (P = 0.003) (P = 0.003), and the average surgery durations were 222 ± 47.8 min and 162 ± 30.2 min, respectively (P = 0.022). The average follow-up duration was 62 ± 19 months, and no cases of recurrence were found at the final follow-up assessment. Conclusions: Multimodal treatment significantly alleviated the clinical symptoms of elderly patients with typical aggressive vertebral hemangiomas. Intraoperative absorbable gelatin sponge injection is a safe and effective way to reduce blood loss and surgery duration.

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Blood Loss in Surgery for Aggressive Vertebral Haemangioma with and without Embolisation

Cited by 39 publications

References 26 publications

Surgical treatment of aggressive vertebral hemangiomas

Surgical treatment of aggressive vertebral hemangiomas

Surgical treatment of aggressive vertebral hemangioma causing progressive paraparesis

Intraoperative injection of absorbable gelatin sponge (AGS) mixed with cement followed by spinal decompression to treat elderly with vertebral hemangiomas

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