Symptomatic vertebral hemangioma in pregnancy treated antepartum. A case report with review of literature

Kamath, Vijay; Shetty, Ajoy Prasad; Rajasekaran, S.

doi:10.1007/s00586-008-0592-2

Cited by 39 publications

(42 citation statements)

References 25 publications

(52 reference statements)

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“…They may also present with a low-intensity signal on T1-weighted sequences and a high-intensity signal on T2-weighted sequences, indicating the active nature of the hemangioma with a risk of deterioration and therefore spinal cord compression. 28 These MRI findings were reported in 2 previously published cases 5,8 and in both of the cases presented here. In particular, in the first case, 2 other hemangiomas presented with a high-intensity signal on T1-and T2-weighted sequences, while the hemangioma responsible for spinal cord compression presented with a low-intensity signal on the T1-weighted sequences.…”

Section: Discussionsupporting

confidence: 80%

“…13 Since that first publication, 27 new cases have been described (Table 1). 1,[3][4][5][6][7][8][9][10][11][13][14][15][16][18][19][20][21][22][23][24][25][26][27][28][29] The diagnosis was usually made during the third trimester (22 of 27 cases). The mean maternal age at the time of diagnosis was 30 years.…”

Section: Discussionmentioning

confidence: 99%

“…This venous hypertension is related to the increased uterine volume, inducing inferior vena cava compression. 19,28 These hemodynamic modifications obviously result in expansion and dilation of the hemangioma. This mechanism is supported by case reports of spontaneous improvement of back pain or neurological deficits after delivery.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9]11,[19][20][21]24,26,28,29 Only half of these cases were treated antepartum. 8,[19][20][21]28 Only 1 of the 8 cases of prematurity (between 32 and 36 weeks of gestation) 1,3,10,[13][14][15]19,23 was treated antepartum. 13 Finally, only 1 of the 7 cases close to term (beyond 36 weeks of gestation) 4,5,16,22,25,27 at the time of diagnosis was treated antepartum.…”

Section: Discussionmentioning

confidence: 99%

“…For example, after antepartum laminectomy and partial neurological recovery in a patient, Schwartz et al 24 described a new episode of neurological deterioration during pregnancy, after which a cesarean section was performed together with another posterior decompression procedure at the same spinal level, allowing complete neurological recovery. Surveillance or treatment of the hemangioma is therefore essential, especially as relapse can also occur after delivery; 28 in this setting, Vijay et al 28 treated a hemangioma by embolization followed by corpectomy.…”

Section: Discussionmentioning

confidence: 99%

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Symptomatic vertebral hemangiomas during pregnancy

Moles¹,

Hamel

Perret

et al. 2014

SPI

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Symptomatic vertebral hemangiomas during pregnancy are rare, as only 27 cases have been reported in the literature since 1948. However, symptomatic vertebral hemangiomas can be responsible for spinal cord compression, in which case they constitute a medical emergency, which raises management difficulties in the context of pregnancy. Pregnancy is a known factor responsible for deterioration of these vascular tumors. In this paper, the authors report 2 clinical cases of symptomatic vertebral hemangiomas during pregnancy, including 1 case of spontaneous fracture that has never been previously reported in the literature. The authors then present a brief review of the literature to discuss emergency management of this condition. The first case was a 28-year-old woman at 35 weeks of gestation, who presented with paraparesis. Spinal cord MRI demonstrated a vertebral hemangioma invading the body and posterior arch of T-3 with posterior epidural extension. Laminectomy and vertebroplasty were performed after cesarean section, allowing neurological recovery. The second case involved a 35-year-old woman who presented with spontaneous fracture of T-7 at 36 weeks of gestation, revealing a vertebral hemangioma with no neurological deficit, but it was responsible for pain and local instability. Treatment consisted of postpartum posterior interbody fusion. With a clinical and radiological follow-up of 2 years, no complications and no modification of the hemangiomas were observed. A review of the literature reveals discordant management of these rare cases, which is why the treatment course must be decided by a multidisciplinary team as a function of fetal gestational age and maternal neurological features.

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Section: Discussionsupporting

confidence: 80%