Percutaneous ethanol embolization and cement augmentation of aggressive vertebral hemangiomas at two adjacent vertebral levels

Cianfoni, Alessandro; Massari, Francesco; Dani, Genta; Lena, Jonathan; Rumboldt, Zoran; Vandergrift, William A.; Bonaldi, Giuseppe

doi:10.1016/j.neurad.2012.10.003

Cited by 15 publications

(9 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although various non-surgical treatment modalities have been described for treating aggressive VHs [5,[13][14][15][16], the outcome is sometimes unsatis ed. Surgical therapy is still the most radical method of clinical treatment of aggressive VHs.…”

Section: Introductionmentioning

confidence: 99%

WITHDRAWN: Aggressive Vertebral Hemangiomas Causing Compression Fracture with Neurological Deficits: A Retrospective Cohort Study

Rao

Liu

et al. 2020

Preprint

View full text Add to dashboard Cite

Background:In rare instances, aggressive vertebral hemangiomas (VHs) can cause compression fracture, resulting in severe pain and neurological deficits. But the diagnosis and treatment of these aggressive lesions are challenging because of these lesions are rare and atypical. This study aimed to evaluate the safety and efficacy of surgical management for aggressive VHs with vertebral compression fracture by a modified multimodality surgery.Methods:We retrospectively reviewed 6 cases suffering from aggressive VHs with compression fracture and neurological deficits in our department from July 2011 to April 2016. These patients were treated by the multimodality surgery, includingpreoperative embolization, intraoperative injection of gelfoam mixed with cement, and laminectomy decompression.The follow-up period was at least 3 years. Perioperative parameters, clinical outcomes, and radiographical data were collected and analyzed.Results: The 6 patients involved 1 male and 5 females (mean age, 52.3 years).The levels involved were: in thoracic spine (5 cases) and lumbar spine (1 case).Preoperative CT-guided biopsy was conducted in all patients, with 5 patients had definitive pathologic diagnosis. All patients were treated successfully with the multimodal surgery, with no cement leakage and other severe complications. The mean operation time was 182.2 minutes, and the estimated blood loss was 908.3 ml.At an average follow-up of 49.8 months, clinical outcomes assessed by the visual analogue scale and Frankel grade were significantly improved. The vertebral body height and kyphosis angle of the fractured vertebra were also corrected postoperatively. No affected vertebra re-fracture and adjacent vertebral fracture were developed, and none of the patients experienced recurrence of tumor at final follow-up.Conclusions:In cases of aggressive VHs causing compression fracture with neurological deficits, CT-guided biopsy is indicated for the diagnosis. The multimodality surgery (preoperative embolization, intraoperative injection of gelfoam mixed with bone cement combined laminectomy decompression) is effective and safe, and can be considered as an acceptable surgical choice.

show abstract

Section: Introductionmentioning

confidence: 99%

WITHDRAWN: Aggressive Vertebral Hemangiomas Causing Compression Fracture with Neurological Deficits: A Retrospective Cohort Study

Rao

Liu

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…17,32,38,55,63,69 To avoid the risk of vertebral collapse, some surgeons may inject lower doses of ethanol or combine ethanol injection with percutaneous vertebroplasty. 13,17 A case report by Chen et al 10 also describes the successful treatment of an aggressive vertebral hemangioma using ethanol injection in combination with endovascular embolization with no clinical or radiographic recurrence at 21-month follow-up. Nevertheless, because there are other treatment options with comparable clinical outcomes and fewer complications, alcohol ablation has fallen out of favor.…”

Section: Ethanol Ablationmentioning

confidence: 99%

Surgical treatment of aggressive vertebral hemangiomas

Vasudeva

John

Groff

2016

FOC

View full text Add to dashboard Cite

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.

show abstract

“…Because of the small number of cases, no consensus exists concerning the gold standard to treat S3 hemangiomas. Currently, the reported treatments for vertebral hemangiomas include radiotherapy [17], interventional embolization [18], alcohol ablation [19,20], vertebroplasty [21], and surgery [2,3,8]. Cloran et al [4] believed that physicians should attend to symptomatic hemangiomas and that multimodal treatments should be used for patients with S3 hemangiomas, which includes preoperative interventional embolization, spinal canal decompression or en bloc.…”

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

View full text Add to dashboard Cite

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.

show abstract

Percutaneous ethanol embolization and cement augmentation of aggressive vertebral hemangiomas at two adjacent vertebral levels

Cited by 15 publications

References 6 publications

WITHDRAWN: Aggressive Vertebral Hemangiomas Causing Compression Fracture with Neurological Deficits: A Retrospective Cohort Study

WITHDRAWN: Aggressive Vertebral Hemangiomas Causing Compression Fracture with Neurological Deficits: A Retrospective Cohort Study

Surgical treatment of aggressive vertebral hemangiomas

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

Contact Info

Product

Resources

About