Aggressive Vertebral Hemangiomas Research Articles

Symptomatic and aggressive vertebral hemangiomas in children: features of modern interpretation and treatment tactics

Objective. To analyze the features of clinical-radiological manifestations of symptomatic vertebral hemangiomas in children and the possibility of algorithmizing their treatment.Material and Methods. As part of a monocenter cohort, 24 children aged 4 to 17 years received treatment for symptomatic vertebral hemangiomas. The clinical-radiological manifestations of the tumor and the effectiveness of various methods of invasive treatment were evaluated.Results. Symptomatic uncomplicated and complicated vertebral hemangiomas, corresponding to stages S2 and S3 of the Enneking classification for benign tumors, occur in children with almost equal frequency. For tumors without extravertebral spread, a closed percutaneous vertebroplasty provides stable relief of complaints. For aggressive hemangiomas with extravertebral, including epidural, spread, various treatment methods are used. An algorithm for choosing therapeutic tactics is proposed.Conclusion. Surgical treatment of symptomatic vertebral hemangiomas should be carried out using a tactical algorithm that takes into account the stage of the tumor (S2 or S3) and the possibility of performing closed or open vertebroplasty, selective arterial embolization and decompression and stabilization operations on the spine.

Preoperative elastoplasty of aggressive vertebral hemangiomas in elderly patients: a new strategy for reducing intraoperative bleeding and complications

PurposePreoperative elastoplasty could be an alternative strategy for treating aggressive vertebral hemangiomas (VHs) in frail patients needing for spinal cord decompression, combining the advantages of embolization and vertebroplasty.MethodsThree elderly patients with spinal cord compression from thoracic aggressive VHs underwent XperCT-guided percutaneous injection of silicone (VK100), filling the whole affected vertebra, followed by a decompressive laminectomy. At 12-months follow-up no recurrences, vertebral collapse or segmental kyphosis were noted at the CT scans, with patients reporting an improvement of preoperative neurological deficits, VAS and Smiley-Webster pain scale (SWPS) parameters.ResultsWith its elastic modulus, non-exothermic hardening, and lower viscosity than PMMA, VK100 allowed a preoperative augmentation of the affected vertebral body, pedicles, and laminae without complications, with a controlled silicone delivery even in part of VH’s epidural components thanks to XperCT-guidance.ConclusionWhen facing highly bony erosive VH encroaching the spinal canal, VK100 combines the advantages of embolization and vertebroplasty especially in elderly patients, permeating the whole VH’s angioarchitecture, significantly reducing tumor.

Cobb Syndrome, A Rare Disease – Case Report

Cobb syndrome is a rare genetic disorder characterized by dermatomal pattern, with corresponding muscular, osseous, paraspinal, and/or spinal vascular lesions occurring at the same body somite (metamere). It is also known as spinal arteriovenous metameric syndrome (SAMS) and cutaneous meningospinal angiomatosis. We present a case of a 36 years old male presented to OPD with Complain of progressive weakness of Right upper limb for 5 years. On examination, Patient had large cutaneous port wine stain on the right side of the chest, nape of neck, and along the whole right upper limb in a dermatomal distribution with ulnar claw hand wasting of thenar muscles on right side. MRI cervical spine with contrast showed aggressive vertebral hemangioma involving anterior and posterior arch of C1 vertebra, vertebral body of C2 to C5, right half of vertebral body of C2 and C6 and right pedicle of C2 to C5 vertebra. Abnormal thickened and T2WI /STIR hyperintense skin and subcutaneous tissue involving right half of scalp and right half of neck which showing post contrast enhancement, possibility of subcutaneous hemangioma. Cobb syndrome was diagnosed based on the dermatomal distribution of the cutaneous vascular lesions and the corresponding vertebral, epidural, and paraspinal vascular lesions occurring at the same metamere. Treatment decision is guided by the patient’s symptoms and imaging features.

Surgical Options for Aggressive Vertebral Hemangiomas：A case series, literature review and treatment recommendations

PurposeWe retrospectively study twenty-nine surgical cases of aggressive vertebral hemangiomas (AVHs) with neurological deficits and extradural compression to determine the optimal surgical treatment strategy for AVHs at a single institution. MethodsPatients with AVHs with neurological deficits who underwent partial tumor resection plus decompression with or without vertebroplasty (VP), and radiotherapy between 2010 and 2021 were included in this study. Clinical characteristics, surgical outcomes, and follow-up data of the patients were reviewed retrospectively. ResultsTwenty-nine AVH cases with neurological deficits and spinal instability were included in this study and treated surgically. The mean operation time of patients with decompression surgery plus VP (Groupe A) was 215.9 (120-265 min), shorter than that of decompression surgery without VP (Group B) 240.2 (120-320 min). Intraoperative blood loss was 273.3 (100–550 mL) in group A and 635.3 (200–1600 mL) in group B. In addition, a significant reduction in blood loss was observed in group A compared to the group B (p=0.0001). All patients experienced immediate pain relief and improvement in their neurological symptoms. Neurological function was assessed by the Frankel score, ASIA score, and the visual analogue scale (VAS) pain score decreased from 7.4 (4-9) to 1.3 (0-3). Of twenty-nine patients in this study, only 7% (2/29 patients) showed signs of recurrence. ConclusionDecompression plus VP achieve good tumor control and decrease surgical complication. Preoperative vascular embolization and VP can reduce intraoperative bleeding in the treatment of AVH surgery. Moreover, postoperative radiotherapy seems to be a good technique to prevent tumor recurrence.

Post-biopsy spontaneous air in vertebrae: A tell-tale sign of vertebral hemangioma

Although most vertebral hemangiomas are asymptomatic and common incidental findings on radiographs and cross-sectional imaging, few atypical vertebral hemangiomas have aggressive imaging features and are clinically symptomatic. This atypical vertebral hemangioma poses a diagnostic dilemma and needs to be differentiated from aggressive vertebral neoplasm-like metastasis or plasmacytoma. Advances in radiological imaging, particularly MRI, help in differentiating atypical hemangioma from aggressive vertebral neoplasm to a certain extent; however, computed tomography-guided biopsy is often required for histopathological confirmation and further management. The aim of the case report is to highlight the finding of post-biopsy spontaneous gas bubble formation inside the vertebra in aggressive vertebral hemangioma, which helps to differentiate it from aggressive vertebral neoplasms.

Ethanol Sclerosis Therapy for Aggressive Vertebral Hemangioma of the Spine: A Narrative Review.

Vertebral hemangiomas of the spine are rare benign tumors. They occur primarily in the thoracic region and are often asymptomatic and found incidentally on radiological examination; however, some are symptomatic, aggressive, and gradually increase in size. Various therapeutic approaches have been proposed for their management. This study aimed to review the therapeutic management, focusing on ethanol sclerosis therapy. The PubMed database was searched from inception to January 2023 using the keywords "hemangioma", "spine OR vertebra", and "ethanol". Twenty studies were retrieved, including two letters. The first report of spinal therapy was published in 1994. Ethanol sclerosis therapy is effective in treating vertebral hemangiomas. It is performed independently or in combination with other techniques, such as vertebroplasty using cement and surgery. The therapy is performed under local or general anesthesia with fluoroscopic or computed tomography guidance. A total of 10-15 mL of ethanol is slowly injected via unilateral or bilateral pedicles. Complications of the therapy include hypotension and arrhythmia during the procedure, paralysis immediately after the procedure, and delayed compression fractures. This review could enable the refinement of knowledge regarding ethanol sclerosis therapy, which is a treatment option that could be adopted.

Thoracic spinal cord compression by an atypical aggressive vertebral hemangioma – A case report

Vertebral hemangiomas are benign vascular lesions of bone , composed of multiple thin-walled vessels surrounded by fat infiltrating the medullary cavity between bony trabeculae.(1) Hemangiomas account for around 2-3% of all spinal tumors and only 0.9-1.2% of these are symptomatic. Surgery is recommended for lesions if they progress rapidly and cause neurological deficits. 47 years old female patient presented with bilateral lower limb weakness due to an aggressive atypical vertebral body hemangioma at D7 level. Patient underwent pre-op embolisation with surgical decompression and stabilization. Neurological recovery was almost complete over a period of 2 months.

The gelfoam technique in aggressive vertebral haemangioma with dorsal myelopathy

The gelfoam technique in aggressive vertebral haemangioma with dorsal myelopathy

Aggressive vertebral hemangiomas in children.

Aggressive vertebral hemangiomas are rare tumors in children, usually occurring in the thoracic spine that can cause significant neurological morbidity. They are technically difficult to treat with significant risk of blood loss during surgery. We describe a case of aggressive vertebral hemangioma managed in our institution. We performed a literature review of reported cases of aggressive vertebral hemangiomas in pediatric age group. We discuss the clinical presentation, diagnosis, and management of these lesions. We identified 23 cases of aggressive vertebral reported in children. Neurodeficit was the most common presentation, and the most common location was the thoracic spine. Surgery was the most common modality of treatment. All the patients reported in literature had improvement in their symptoms after treatment. Although technically challenging, aggressive vertebral hemangiomas have a good outcome after treatment. Treatment should be tailored to the individual patient. Further studies are needed to determine the optimum treatment strategy.

Management of Aggressive Vertebral Haemangioma and Assessment of Differentiating Pointers Between Aggressive Vertebral Haemangioma and Metastases - A Systematic Review.

Systematic review. Vertebral haemangioma has been classified into typical and aggressive vertebral haemangioma (AVH). Management options for AVH are many and the clinician has decision dilemma in choosing the right one. Metastases mimic AVH in clinical and radiological presentation. Differentiating pointers between them has not been clearly delineated in literature. Aim of our review is to identify treatment options; to formulate a management algorithm for AVH based on clinical presentation and to identify radiological differentiating pointers between them. Systematic review was conducted according to PRISMA guidelines. We systematically reviewed all available literature from the year 2001 to 2020. Relevant articles were identified as per laid down criteria from the medical databases. After inclusion, first and second authors went through full text of each included article. Of 139 studies reviewed, eight met our criteria for review of management and three separate studies for radiological differentiating pointers. 99 patients with 88 AVH had undergone treatment. Back pain with myelopathy is the presenting symptom in majority of patients. Patients with backpain - myelopathic symptoms had improved following surgery; patients with back pain alone had improved with either percutaneous vertebroplasty or CT guided alcohol ablation. Dynamic contrast MRI, Diffusion weighted MRI and ratio of signal intensity between T1w and fat suppression T1w MR help the clinician in differentiating them. Management of AVH can be based on the patient's clinical presentation. Patients presenting with AVH and back pain can be managed with either Percutaneous vertebroplasty or CT guided alcohol ablation. Patients presenting with AVH and neurological symptoms could be managed with surgery. Dynamic contrast enhanced MR, Diffusion weighted MR, ratio of signal intensity between T1w and Fat suppression T1w MR imaging could help the clinician in differentiating the two before contemplating biopsy. C.

In Vertebral Hemangiomas with Neurological Deficit, Is a Less Extensive Approach Adequate.

This was a retrospective study. To analyze the surgical and neurological outcomes following surgical decompression in patients with aggressive vertebral hemangioma (AVH) presenting with neurological deficit and to determine whether a less extensive approach is appropriate. AVHs are a rare subset of benign vascular tumors frequently presenting with neurological deficit because of spinal cord compression. Though the results of surgical management have improved over time, there is a lack of consensus on the ideal management in this group of patients. Twenty-one patients who underwent surgery for AVH between 2009 and 2018 were analyzed. Demographic and clinical details of patients were retrieved from hospital information system. Imaging information (i.e., radiography, computed tomography, magnetic resonance imaging) of all patients was accessed and analyzed in picture archiving and communication system. Tumor staging was performed using Enneking and Weinstein-Boriani-Biagini classifications and Spinal Instability Neoplastic Score. At followup, neurological and radiological evaluations were performed. Twenty-one patients (13 [61.9%] females and 8 [38.1%] males) were included with a mean age of 44.29 years (range, 14-72 years). All patients in the study had neurological deficit. Back pain was present in 80.9% of patients. Mean duration of symptoms was 4.6 months (range, 1 day to 10 months). Most common lesion location was thoracic spine (n=12), followed by thoracolumbar (D11- L2; n=7) and lumbar (n=2) regions. Ten patients had multiple level lesions. All patients underwent preoperative embolization. Nine patients underwent intralesional spondylectomy with reconstruction; another nine patients underwent stabilization, decompression, and vertebroplasty; three patients underwent decompression and stabilization. Neurology improved in all patients, and only one case of recurrence was noted in a mean follow-up of 55.78±25 months (range, 24-96 months). In AVH, good clinical and neurological outcomes with low recurrence rates can be achieved using less extensive procedures, such as posterior instrumented decompression with vertebroplasty and intralesional tumor resection.

Incidental Ga-68 DOTATATE uptake in an aggressive vertebral hemangioma

Incidental Ga-68 DOTATATE uptake in an aggressive vertebral hemangioma

Application of a combined approach in the patient treatment with aggressive hemangiomas of the spine

Aggressive hemangioma of the spine is a benign vascular tumor. Stabilization, vertebroplasty, partial resection or total corpectomy of the affected vertebra, radiation therapy are known methods of treatment. Vertebral hemangiomas are more likely to be asymptomatic. Accordind to literature review 3–5 % of hemangiomas are symptomatic (pain). In 1.0 % of cases, hemangiomas cause symptoms of compression of nerve structures, spreading epidurally around the spinal cord and / or radicular nerves. A clinical case of a 63-year-old patient who underwent surgery in 2016 at another clinic for aggressive vertebral hemangiomas Th4 was presented. Bisphosphonate treatment was performed. Despite treatment, progressive lower extremities paraparesis was observed. Spinal angiography and total embolization of hemangiomas with liquid embolizing substances were performed. Immediately after embolization, the patient noted a pain intensity decrease. Surgery was performed in 40 minutes after transarterial embolization (removal of transpedicular stabilizing metal system, laminectomy of Th4 vertebra, decompression of the spinal cord, partial removal of Th4 hemangioma biopsy). The volume of intraoperative blood loss was 200 ml. Wound suction drainage was removed on the second postoperative day. No systemic complications (deep vein thrombosis, pneumonia) were noted. The patient was verticalized on the second postoperative day. After surgery, neurological function corresponded to the preoperative level (Frankel C). Regression of neurological deficit was observed (increased strength and range of motion of the lower extremities, bladder function improvement) the 5th postoperative day (Frankel D-E), Histological examination confirmed the diagnosis of hemangiomas. The patient was discharged from hospital with neurological improvement. Radiation therapy was recommended. 3 months after surgery, neurological function was assessed as Frankel E.

Three-dimensional printing-assisted anterior and posterior combined surgery for treating a giant aggressive vertebral hemangioma

Aggressive vertebral hemangioma (AVH) is a type of non-neoplastic and congenital developmental abnormality of spinal cord blood vessels. We report the innovative application of three-dimensional (3D) printing-assisted anterior and posterior combined surgery for treating a giant AVH. This could be a novel treatment in the future. A 44-year-old man suffered from persistent neck pain and limited limb mobility for approximately 2 weeks. An imaging examination showed the destruction of C2–4 vertebral bodies, and a giant lesion invaded the spinal cord. He underwent 3D printing-assisted anterior and posterior combined surgery. Postoperatively, his symptoms of persistent neck pain and limited limb mobility were alleviated. An imaging examination showed that internal fixation and the prosthesis were fixed in place, and the spinal canal was unobstructed. Treating a giant AVH by 3D printing-assisted anterior and posterior combined surgery is feasible and effective.

Surgical management of aggressive vertebral hemangioma: Case series and review of literature

Surgical management of aggressive vertebral hemangioma: Case series and review of literature

Vertebral Body Infarction after Transarterial Preoperative Embolization of a Vertebral Hemangioma.

Vertebral hemangioma resection can be a real challenge for spine surgeons, given the high potential of massive intraoperative bleeding. For this reason, preoperative transarterial embolization of this tumor is supported by the available literature. Here, we discuss our difficulties in interpreting an unusual clinical and radiologic picture related to the endovascular procedure. A 45-year-old man was referred to our department due to chronic back pain and progressive lower extremity weakness. Radiologic assessment was obtained by means of spinal computed tomography (CT) and magnetic resonance imaging (MRI), which showed an aggressive vertebral hemangioma in T7, compressing the spinal cord. The patient underwent a combined therapeutic approach consisting of preoperative transarterial embolization followed by tumor resection, spinal cord decompression, and posterior thoracic arthrodesis. The patient was dismissed with neither strength nor sensory deficits. Two weeks later, he returned to our department with fever. A new MRI demonstrated multiple areas of altered signal in almost all vertebral bodies from T6 down to the sacrum. After a deep diagnostic process, including new MRI and infectious disease evaluations, the definitive diagnosis of multiple vertebral bone infarction was suggested. Vertebral infarctions are an extremely rare complication of spinal endovascular procedures. To our knowledge, this is the first case of multiple postembolization vertebral infarctions, without spinal cord involvement. This peculiarity was explained by the presence of direct anastomoses between a posterior intercostal artery and the underlying vertebral bodies.

Баллонная кифопластика в хирургическом лечении агрессивных гемангиом позвоночника (обзор литературы)

Introduction Aggressive vertebral hemangiomas occur in 10–11.5 % of the working-age population that determines social significance of the disease. Percutaneous vertebroplasty technique is normally used for the treatment of aggressive spinal hemangiomas. Cement leakage is the most common complication during vertebroplasty (40–87. 5 %). Balloon kyphoplasty is associated with a low incidence of cement leakage. Objective We aimed to analyze literature and summarize information on balloon kyphoplasty used to treat aggressive spinal hemangiomas. Material and methods The original literature search was conducted on key resources including PubMed and GoogleScholar. Literature searches included both Russian and English studies based on keywords. Results and discussion The article presents the main results of balloon kyphoplasty used as a standalone procedure and in combination with other methods of surgical treatment of aggressive spinal hemangiomas. The use of balloon kyphoplasty was shown to reduce the risk of extraspinal cement leakage. However, this aspect is represented by a small number of scientific publications in the current medical literature that emphasizes the relevance of the topic raised. Conclusion Despite the variety of available treatment options, the optimal management strategy remains controversial for aggressive forms of vertebral hemangiomas. There are no well-defined criteria and indications reported recently to be included into a well-structured algorithm for of balloon kyphoplasty in the treatment of aggressive spinal hemangiomas, and therefore the debatable questions need further investigation.

Utility of spinal angiography and arterial embolization in patients undergoing CT guided alcohol injection of aggressive vertebral hemangiomas.

The purpose of this study is to evaluate the role of spinal angiography and arterial embolization in avoiding spinal cord ischemia in patients undergoing CT-guided alcohol injection of aggressive vertebral hemangiomas. In this retrospective study, patients with vertebral hemangioma who underwent CT-guided direct alcohol injection between January 2007 and October 2018 were identified. Of 28 such patients, 26 had neurological deficits, and 2 had only back pain or radiculopathy. Direct alcohol injection without prior arterial embolization was done in 17 patients. Direct alcohol injection with prior arterial embolization was done in 11 patients. Clinical outcome was assessed immediately after the intervention and at follow-up. Three patients, who underwent alcohol injection without trans-arterial embolization, had worsening of neurological deficits in the post procedure period due to spinal cord ischemia. No complications related to spinal cord ischemia were noted in the embolization group. There was no significant difference in the outcomes between the two groups if the three patients with complications are excluded (p = 0.34). While CT-guided direct alcohol injection is effective in the management of symptomatic and aggressive vertebral hemangiomas, spinal angiography and trans-arterial embolization of the blood supply to the vertebral body hemangioma, prior to the direct transpedicular alcohol embolization of the lesion, improves the safety of the procedure.

Lifesaving Successful Embolization of Aggressive Vertebral Body Hemangioma and a Large Pulmonary Arteriovenous Malformation

Vertebral hemangiomas are incidental finding and most of the time do not necessitate immediate attention unless symptomatic. Vertebral hemangiomas can be very aggressive to the extent that they can produce cord compression and paraplegia/paraparesis. Such cases need evaluation with magnetic resonance imaging to assess the cause, extent, and mass effect on the spinal cord. Transcatheter embolization and decompression surgery are well established modes of treatment as single or combined approach. Pulmonary arteriovenous malformation (AVM) is caused by the direct communication of main pulmonary artery with pulmonary vein, leading to a high-flow right-to-left shunt. This usually presents clinically as hypoxia, cyanosis, and dyspnea. The clinical signs and symptoms vary depending on the size, number, and flow of fistula as well as the associated vascular malformations. Transcatheter embolization is a treatment of choice for pulmonary AVM. However, this method may result in incomplete resolution if the malformation is large in size or supplied by multiple feeding arteries. Surgical resection may be considered in those kinds of cases. As AVM can lead to hemodynamical instability, these lesions need to be addressed first. In this case, pulmonary AVM came to notice post surgical decompression. Here, we report a case of aggressive vertebral body hemangioma and a large pulmonary AVM in the same patient, which were treated by embolization in two different settings.

Percutaneous vertebroplasty with or without sclerotherapy for the treatment of symptomatic spinal haemangiomas: study of clinical safety and efficacy

Purpose : To illustrate safety and efficacy of percutaneous vertebroplasty (either solely performed or in combination to alcohol sclerotherapy) for treatment of symptomatic, aggressive vertebral haemangiomas in a series of consecutive patients. Material and Methods : Institutional database research from 1/1/2010 until 31/8/2020 identified 25 patients with 31 symptomatic, aggressive vertebral haemangiomas suffering from pain with or without neurologic compromise underwent percutaneous vertebroplasty either solely performed or in combination to alcohol sclerotherapy. When haemangioma was restrained to the vertebral body, percutaneous vertebroplasty was performed as the only treatment technique. When an epidural component was also present causing pressure effects upon the spinal sac, sclerotherapy was additionally performed with alcohol injection at the level of the vertebral pedicles. CT scan assessed implant distribution the morning post therapy and MRI was performed 6 months post. Numeric Visual pain scores (NVS) prior- and post-treatment were compared using Paired Samples t-Test and Wilcoxon Signed Rank Test. Results : Mean pain score prior to any therapy was 8.52 ± 1.388 NVS units. Mean pain score at 12 months post therapy was 1.68 ± 2.445 NVS units. There was a mean reduction of 6.84 ± 3.145 NVS units. The comparison of the patients’ self-reported outcomes concerning pain reduction and mobility improvement prior and post therapy was considered statistically significant (p<0.001). No complication was noted. Conclusions : Percutaneous vertebroplasty (either solely performed or in combination to alcohol sclerotherapy) seems to be a safe and efficient technique for the treatment of symptomatic, aggressive vertebral haemangiomas resulting in significant pain reduction and mobility improvement. Proper patient selection is a prerequisite for high success rate.