Surgical treatment of aggressive vertebral hemangiomas

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>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.</jats:p></jats:sec>

WITHDRAWN: Aggressive Vertebral Hemangiomas Causing Compression Fracture with Neurological Deficits: A Retrospective Cohort Study

“…Surgical therapy is still the most radical method of clinical treatment of aggressive VHs. The surgical procedures mainly involved laminectomy decompression, intralesional vertebrectomy, and en-bloc spondylectomy; butthe formulation of ideal surgery for treating these lesions is still a matter of debate because of the rarity ofaggressive VHs [4,6,7,17].In this study, we reported 6 patients with compression fracture caused by aggressive VHs. These patients were treated with our modi ed multimodality surgery (preoperative embolization, intraoperative injection of gelfoam mixed with bone cement combined laminectomy decompression).…”

“…For asymptomatic VHs, treatment is unnecessary. However, in rare instances, VHs can present as a locally aggressive behave way by enlarging and extending into the spinal canal and/or paravertebral space, leading to spinal cord compression [3][4][5][6]. Aggressive VHs oftenexhibit several symptoms, including local back pain, radicular pain, or even neurological de cits.…”

The Role of Radiotherapy and Surgery in the Management of Aggressive Vertebral Hemangioma: A Retrospective Study of 20 Patients

“…Vertebral hemangioma is a rare, benign vascular tumor of the vertebral body that is usually asymptomatic, but which can behave in a locally aggressive way by involving bone and local spread into the vertebral canal to cause spinal cord compression. Between 0.9–1.2% of vertebral hemangiomas are aggressive, or symptomatic [ 1 – 6 ], with aggressive vertebral hemangioma extending into the spinal canal and/or paravertebral space, leading to neurological deficit [ 2 , 4 , 7 – 12 ]. The choice of treatment for aggressive vertebral hemangioma is controversial, and in the literature, most previous reports have focussed on surgical management [ 2 , 4 , 7 , 8 , 11 – 14 ].…”

Results of Differentiated Surgical Treatment of Aggressive Vertebral Hemangiomas

“…Декомпрессивно-стабилизирующее вме-шательство с интраоперационной открытой вертебропластикой пораженного позвонка является безопасным и эффективным методом лечения агрессивной гемангиомы позвонка типа IIIB. В 2016 г. Vasudeva et al [41] опубликовали данные о хирургическом лечении агрессивных гемангиом IIIВ типа. В 80 % случаев после операции неврологическая симптоматика регрессировала.…”