Effectiveness of postoperative radiation therapy for thoracic spine hemangioma recurrence

Abstract

Vertebral hemangiomas are the most common benign tumor of the spine. Although usually asymptomatic, there is a higher risk of severe neurological deficits when hemangiomas afflict the thoracic spine. The management of vertebral hemangioma patients with extraosseous extension causing neurological dysfunction has not yet been established. We described the effectiveness of surgical and radiation therapy in a case of recurrent hemangioma in the thoracic spine with extraosseous extension causing progressive paraparesis. We retrospectively reviewed a case of vertebral recurrent hemangioma treated by posterior spinal decompression and fusion and subsequent radiation therapy.A 61-year-old woman suffered from neurological deficits caused by a hemangioma in the thoracic spine. Despite initial treatment by posterior decompression, subtotal transpedicular tumor resection, and posterior spinal fusion, her neurological symptoms due to tumor compression recurred 5 years later. Posterior-approach anterior spinal cord decompression by subtotal transpedicular tumor resection was attempted next but her paraparesis continued to worsen. Radiotherapy of a total of 32 Gy in 16 fractions restored mobility and lesion size was markedly reduced 7 months later. Even 14 months after surgery, she has been able to walk although she has slightly paralysis of the lower extremity remaining.Subtotal transpedicular tumor resection, and especially additional radiation therapy, was effective in reducing tumor volume and improving neurological dysfunction caused by a thoracic spine recurrent hemangioma.