Minimally Invasive Decompression and Stabilisation for Extensive Haemangiomas of Lumbar Spine

Gnanalingham, K. K.; Afridi, Marwa; AbouZeid, Amr Abdelhamid; Herwadkar, Amit

doi:10.1055/s-0030-1267925

Cited by 5 publications

(2 citation statements)

References 5 publications

(27 reference statements)

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“…14 Although embolization is often performed preoperatively to reduce intraoperative blood loss, embolization without resection has also been shown to offer clinical improvement in select patients. 6,[15][16][17][18][19] Given the benign appearance of our patient's lesion on imaging and his relatively asymptomatic course, embolization and short-segment fixation were offered with close postoperative monitoring. Embolization of hemangiomas has been traditionally performed transarterially under fluoroscopy.…”

Section: Discussionmentioning

confidence: 99%

Transpedicular Onyx embolization of a thoracic hemangioma with robotic assistance: illustrative case

Hersh

Jin

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Hemangiomas are common benign vascular lesions that rarely present with pain and neurological deficits. Symptomatic lesions are often treated with endovascular embolization. However, transarterial embolization can be technically challenging depending on the size and caliber of the vessels. Moreover, embolization can result in osteonecrosis and vertebral collapse. OBSERVATIONS Here the authors report the first case of a T10 vertebral hemangioma treated with transpedicular Onyx embolization aided by a robotic platform that guided pedicle cannulation and Craig needle placement. An intravenous catheter was attached to the needle and dimethylsulfoxide was infused, followed by Onyx under real-time fluoroscopy. Repeat angiography demonstrated significantly reduced contrast opacification of the vertebral body without compromise of the segmental artery. A T9–11 pedicle screw fixation was performed to optimize long-term stability. The patient’s symptoms improved and was stable at the 6-month follow-up. LESSONS Transpedicular embolization of vertebral hemangiomas can be performed successfully under robotic navigation guidance, avoiding complications seen with the intra-arterial approach and allowing for simultaneous pedicle screw fixation to prevent collapse and delayed kyphotic deformity. During the same procedure, a biopsy specimen can be collected for pathology. This technique can help to alleviate patient symptoms while avoiding complications associated with transarterial embolization or open resection.

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Section: Discussionmentioning

confidence: 99%

Transpedicular Onyx embolization of a thoracic hemangioma with robotic assistance: illustrative case

Hersh

Jin

et al. 2023

Journal of Neurosurgery: Case Lessons

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“…Many substances can be used for embolisation depending of the size of the vessel and the desired length of occlusion [ 3 ]. Liquid embolic agents (i.e., Onyx) [ 4 ], sclerosing agents (i.e., ethanol) [ 5 ], particulate embolic agents (i.e., polyvinyl ethanol) [ 6 ], and mechanical occlusion devices (i.e., coils) are commonly used as embolising agents.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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Despite their benign nature some symptomatic aggressive vertebral haemangiomas (AVH) require surgery to decompress spinal cord and/or stabilise pathological fractures. Preoperative embolisation may reduce the considerable blood loss during surgical decompression. This systematic review investigated whether preoperative embolisation reduced surgical blood loss during treatment of symptomatic AVH. PubMed Medline, Web of Science, and Ovid Medline were searched for case reports and clinical studies on surgical AVH treatment. Included were cases from all publications on surgical treatment of AVH where the amount of surgical blood loss and the use of preoperative embolisation were documented. 51 cases with surgically treated AVH were retrieved from the included studies. Blood loss in the embolised treatment group (980±683 mL) was lower than the non-embolised control group (1,629±946 mL). This systematic review found that embolisation prior to AVH resection reduced surgical blood loss (level of evidence, very low) and can be recommended (strong recommendation).

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Combined surgical and endovascular approach for treatment of aggressive vertebral haemangiomas

Eichberg

Starke

Levi

2017

British Journal of Neurosurgery

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Minimally Invasive Decompression and Stabilisation for Extensive Haemangiomas of Lumbar Spine

Abstract: Combinations of embolisation, vertebroplasty and minimally invasive posterolateral instrumentation are treatment strategies that can be used to treat extensive vertebral haemangiomas presenting with neurological deficits.

Cited by 5 publications

References 5 publications

Transpedicular Onyx embolization of a thoracic hemangioma with robotic assistance: illustrative case

Transpedicular Onyx embolization of a thoracic hemangioma with robotic assistance: illustrative case

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

Combined surgical and endovascular approach for treatment of aggressive vertebral haemangiomas

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