Per-operative glue embolization with surgical decompression: A multimodality treatment for aggressive vertebral haemangioma

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> The aim of this study is to share our experience in per-operative embolization of aggressive vertebral haemangioma and to compare the surgical outcome with existing modalities of management. </jats:p></jats:sec><jats:sec><jats:title>Background</jats:title><jats:p> Vertebral haemangioma accounts for 12% of benign lesions of the vertebral column detected incidentally. Rarely they may enlarge, cause pain and neurological deficit because of spinal cord compression, vertebral body or arch expansion, or pathological fracture. Treatment options for symptomatic vertebral haemangioma include pre-operative transarterial embolization, surgical excision, radiotherapy, and percutaneous injection of alcohol or methyl methacrylate. We present our experience of per-operative glue embolization for aggressive (Enneking stage 3) vertebral haemangiomas. </jats:p></jats:sec><jats:sec><jats:title>Materials and methods</jats:title><jats:p> We describe five patients with symptomatic vertebral haemangioma at the dorsal level who underwent per-operative glue embolization. After initial laminectomy, a tumorogram was obtained under fluoroscopic guidance through direct contrast injection via spinal needle inserted through the pedicles of vertebra at the involved level. Varied concentration of glue was injected via the same spinal needle. All patients underwent surgical decompression of the intraspinal epidural component in the same sitting along with posterior spinal stabilization of the adjacent levels in two patients. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> In all five patients, complete embolization of the tumour was possible per-operatively through the transpedicular approach along with adjunctive surgical decompression, and the blood loss was significantly less. Clinical follow-up of these patients at 12–48 months showed reduction in size of the epidural component, relief of cord compression, and significant improvement in their neurological deficits with no recurrence. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> We conclude that per-operative embolization is a safe and efficacious adjunctive procedure with surgical decompression with or without spinal stabilization for the treatment of symptomatic vertebral haemangiomas. </jats:p></jats:sec>

Role of combined vertebroplasty and spinal decompression in the management of aggressive vertebral hemangiomas

“…The selection depends on many factors such as clinical presentation, radiological features, expected outcome, possible complication, learning curve, technical requirements, and treatment costs. [ 27 28 29 ]…”

“…The selection depends on many factors such as clinical presentation, radiological features, expected outcome, possible complication, learning curve, technical requirements, and treatment costs. [27][28][29] Surgical decompression can be done either through posterior laminectomy or through a more extensive approach in the form of corpectomy and/or spondylectomy. They are indicated in the presence of rapidly progressive or severe neurological symptoms.…”

Re: Per-operative glue embolization with surgical decompression: A multimodality treatment for aggressive vertebral haemangioma

“…In a resource-limited country like ours, we need to reduce the cost of procedures to cater to our population with the least number of recurrences. 2 The experience with vertebroplasty has not been a very good one in our setup. So we refrain from using this technique in an already complicated surgical procedure.…”

“…In a resource-limited country like ours, we need to reduce the cost of procedures to cater to our population with the least number of recurrences. 2…”

Re: Per-operative glue embolization with surgical decompression: A multimodality treatment for aggressive vertebral hemangioma

“…To the Editor, I read with interest the research by Prabhuraj et al in recent issue of Interventional Neuroradiology. 1 The article points out that per-operative embolization is a safe and efficacious adjunctive procedure with surgical decompression with or without spinal stabilization, I cannot agree more. Moreover, there is currently no uniform standard for the treatment of invasive hemangioma.…”