Transpedicular N-butyl cyanoacrylate–mediated percutaneous embolization of symptomatic vertebral hemangiomas

Yao, Kevin C.; Malek, Adel M.

doi:10.3171/2013.1.spine11173

Cited by 17 publications

(9 citation statements)

References 18 publications

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“…16,32 As an alternative, transpedicular embolization with NBCA has been described, and this may be useful when transarterial embolization is unsafe. 28,71 surgery Surgical decompression and gross-total resection are commonly performed in the treatment of aggressive vertebral hemangiomas. Acosta et al 2 performed a retrospective review of 10 cases involving patients who underwent gross-total resection of aggressive vertebral hemangiomas with preoperative embolization followed by intralesional spondylectomy.…”

Section: Endovascular Embolizationmentioning

confidence: 99%

Surgical treatment of aggressive vertebral hemangiomas

Vasudeva

John

Groff

2016

FOC

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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.

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Section: Endovascular Embolizationmentioning

confidence: 99%

Surgical treatment of aggressive vertebral hemangiomas

Vasudeva

John

Groff

2016

FOC

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“…The postoperative neurological outcomes were generally positive in the published cases, irrespective of the surgical method. Only one out of the 51 cases did not show postoperative improvement ( Table 1 ) [ 12 13 14 15 16 17 18 19 20 21 22 23 24 25 ].…”

Section: Resultsmentioning

confidence: 99%

Blood Loss in Surgery for Aggressive Vertebral Haemangioma with and without Embolisation

et al. 2015

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Despite their benign nature some symptomatic aggressive vertebral haemangiomas (AVH) require surgery to decompress spinal cord and/or stabilise pathological fractures. Preoperative embolisation may reduce the considerable blood loss during surgical decompression. This systematic review investigated whether preoperative embolisation reduced surgical blood loss during treatment of symptomatic AVH. PubMed Medline, Web of Science, and Ovid Medline were searched for case reports and clinical studies on surgical AVH treatment. Included were cases from all publications on surgical treatment of AVH where the amount of surgical blood loss and the use of preoperative embolisation were documented. 51 cases with surgically treated AVH were retrieved from the included studies. Blood loss in the embolised treatment group (980±683 mL) was lower than the non-embolised control group (1,629±946 mL). This systematic review found that embolisation prior to AVH resection reduced surgical blood loss (level of evidence, very low) and can be recommended (strong recommendation).

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“…We did not consider direct transpedicular percutaneous onyx embolization, but utilization of this technique may have been useful in this case due to the dangerous angioarchitecture of the tumor. 15 Involvement of radiculomedullary feeders to the anterior spinal artery are a known risk of spinal vascular lesions and a contraindication to embolization due to the possibility of anterior spinal artery embolization. Interestingly, the appearance and size of this artery closely resemble the hairpin appearance of the artery of Adamkiewicz, which is the major contributor to the anterior spinal artery.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Vertebral Hemangioma of the Posterior Elements Sharing Blood Supply with a Radiculomedullary Artery

2018

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Vertebral hemangiomas are common lesions usually restricted to the vertebral body. They are characterized by proliferation of endothelial cells and subsequent expansion of vascular spaces within the bone. These lesions are usually clinically silent and are discovered incidentally. Only rarely are vertebral hemangiomas symptomatic. Here, we present the case of a 68-year-old female with an aggressive hemangioma causing neurologic deficit. The lesion was localized within the posterior spinal elements, with no involvement of the vertebral body. Transarterial embolization was deemed unsafe due to the close proximity of a prominent radiculomedullary artery. The patient was treated with posterior decompression at T4-T6.

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Transpedicular N-butyl cyanoacrylate–mediated percutaneous embolization of symptomatic vertebral hemangiomas

Cited by 17 publications

References 18 publications

Surgical treatment of aggressive vertebral hemangiomas

Surgical treatment of aggressive vertebral hemangiomas

Blood Loss in Surgery for Aggressive Vertebral Haemangioma with and without Embolisation

Symptomatic Vertebral Hemangioma of the Posterior Elements Sharing Blood Supply with a Radiculomedullary Artery

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