Outcome of dorsolumbar vertebral hemangiomas presenting with neuraxial compression

Abstract

Background:Hemangiomas are benign vascular tumors associated with proliferation of blood vessels in bone or soft tissue and they are usually incidental findings in vertebrae. When symptomatic, they present with features of radiculopathy, myelopathy, or vertebral fractures. Treatment options are varied, include sole embolization, embolization combined with surgical excision, surgical excision alone, percutaneous ablation, and radiotherapy. We hereby describe a series of seven cases of symptomatic vertebral hemangiomas operated from 2006 to 2009.Materials and Methods:Their clinical and radiological profile and outcome have been described. All patients were subjected to surgical excision followed by instrumentation. Outcome was assessed at a followup of 2 years following surgery with Frankel grading system.Results:Seven patients (five females and two males) were included in the study. The mean age was 33.85 years with the mean duration of symptoms of 12 months. All seven cases were symptomatic vertebral hemangiomas with cord compression and underwent surgical excision. Preoperatively, patients with poor Frankel grade such as A and B improved postoperatively to C, D, or E.Conclusion:Surgical excision of these lesions is difficult due to the tremendous amount of intraoperative bleeding. During surgery, brisk bleeding is usually encountered, but can be brought under control with adequate preoperative preparation and expertize. Preoperative embolization may help to reduce the bleeding, but at times it may be difficult to do if vertebrae are replaced by a solid hard mass. In spite of the risks associated with surgery, it still is the treatment of choice as a single intervention, especially in aggressive vertebral hemangiomas.

Aggressive Hemangioma of the Thoracic Spine with Cord Compression: A Case Report

“…On MRI of an asymptomatic hemangioma, due to the presence of abundant fatty tissue and high vascularity, it is observed in hyper intense in T1. If fat becomes aggressive, the vascularity reduces; as a result T1 turns into hypo and T2 to hyper (5,6,10). CT scan is the gold standard to diagnose hemangioma and shows the extent of the body involvement and posterior elements, the number of vertebrae involved and the presence of cord compression (4).…”

“…The symptomatic and aggressive type is rare and mostly requiring intervention (9). Therapeutic modalities include radiotherapy, intra-arterial embolization, percutaneous vertebroplasty during surgery, ethanol injection into the lesion, and other types of aggressive surgical Radiotherapy is not indicated if there is neurological involvement since it responds late and, as the edema increases, neurological involvement may be exacerbated (6,10). Also, in case of possible unstable vertebrae, radiotherapy is preferable (6).…”

“…Injection of cement in cases with neurological involvement should not be performed alone, except that it is conducted along with laminectomy and fixation during surgery or with delay after several weeks (10).…”

“…size of the hemangioma and decreasing the pressure on the cord. The injection should be performed in the blood vessels of hemangiomas (10). Decompression surgery can be performed by laminectomy or corpectomy.…”

First reported treatment of aggressive hemangioma with intraoperative radiation therapy and kyphoplasty (Kypho-IORT)

“…Correspondly, a laminectomy could be combined with intraoperative vertebroplasty or alcohol injection, which may shrink the hemangiomas and lead to intralesional thrombosis [4] . Spondylectomy is only indicated for ventrally located lesions with bony compression [5] .…”