Symptomatic Hemangiomas Research Articles

Percutaneous Vertebroplasty for Cervical Symptomatic Hemangiomas and Spinal Metastases: A Case Series and Literature Review

ObjectivesPercutaneous vertebroplasty (PVP) is a commonly used technique for the treatment of spinal diseases, but it's rarely employed for cervical lesions. This study presents a case series and a literature review to evaluate the efficacy of cervical PVP. MethodsFrom August 2013 to January 2023, 14 patients underwent cervical PVP in the author's institution. The mean postoperative follow-up time was 20.3 ± 12.1 months (ranging from 5 to 41 months). The pain status and quality of life were assessed preoperatively, postoperatively, and during follow-up using the Visual Analogue Scale (VAS) and Neck Disability Index (NDI). Additionally, complications that occurred during the study period were documented. ResultsThe series of cases included nine cases of hemangiomas and five cases of spinal metastases. The common symptom was axial pain in the neck. All patients were successfully treated with PVP. VAS scores decreased from 6.6 ± 0.8 preoperatively to 1.9 ± 0.8 at 24 hours postoperatively and to 2.4 ± 1.2 at the last follow-up (P < 0.01). NDI decreased from 22.3% ± 8.9% preoperatively to 7.6% ± 8.1% at 24 hours postoperatively and to 6.0% ± 7.2% at 12-month follow-up (P < 0.01). After the operation, a case of dysphagia occurred, but no major complications were observed during the follow-up period. ConclusionsCervical PVP via the anterolateral approach is a safe option for the treatment of cervical symptomatic hemangiomas and spinal metastases with limited invasiveness. It is effective in relieving pain and improving quality of life.

Spinal Giant Cell Tumor in Neurospine Surgery: A Narrative Study

Background and Aim: Spinal Giant Cell Tumor (GCT) is a primary low-grade malignant aggressive tumor of the spine and is more prevalent in the third and fourth decades of life. Spinal GCT frequently occurs in the sacrum. The most common presentation of spinal GCT is pain. Spinal GCT is seldom observed as an asymptomatic, incidental radiological occurrence. Based on the clinic-radiological findings, differential diagnoses of spinal GCT are Aneurismal Bone Cyst (ABC), plasmacytoma, symptomatic hemangioma, and Tuberculosis (TB). A biopsy is crucial for a definitive diagnosis. Because of the rich vascular supply about 24 hours prior to operation, Digital Subtraction Angiography (DSA) with tumor embolization is recommended. The treatment of choice for these tumors is complete, extralesional surgical resection which is not usually possible. General treatment is resorted as incomplete partial resection following local radiotherapy. The method of choice for reconstruction is cement or metallic cages and because of the high recurrence rate, bone graft is avoided. The local recurrence rate in the spinal column is lower than in other areas. Methods and Materials/Patients: The spinal GCT incidence, manifestations, diagnosis, and management were concisely reviewed. Using the keywords of GCT, GCT manifestations, GCT complications, GCT management, and GCT incidence, all the relevant articles were retrieved from Google Scholar, Medline, and PubMed, reviewed critically, and analyzed. Results: Spinal GCT rarely presents as an incidental finding in radiologic studies. Because of the high vascular supply of GCTs, preoperative embolization must be performed. The ideal treatment of spinal GCT is complete surgical tumor excision and when not possible, intralesional resection is an alternative treatment. The prognosis of spinal GCT is not good as other primary spinal tumors because of incomplete excision of the tumor and following high recurrence rate. Conclusion: Spinal GCTs are complex clinical entities. Operation is obligatory, and postoperative close follow-up is mandatory to stop recurrences early

Giant Exophytic Cavernous Hemangioma Of The Liver In A Middle-aged West-african Woman: A Case Report

Background: Hemangiomas are the most common benign liver tumor. While the majority of these lesions remain asymptomatic, the giant ones often produce symptoms that would prompt intervention. Modern imaging studies have made diagnosing most of these lesions pre-operatively possible. However, as our case presentation illustrates, in resource-poor countries with limited availability of modern imaging studies, diagnosis may still be delayed. Case Report: We present a 54-year-old woman who was referred to us on account of a symptomatic abdominal mass that was found, on ultrasound, to be heterogenous in nature and located in the upper abdomen. She was subsequently able to do only an abdominal computed tomography, which was not typical for the diagnosis of hemangioma. She had surgical resection of the liver mass with an uneventful recovery. Her symptoms resolved afterwards, and the mass was confirmed to be a hemangioma histologically. We reviewed the clinical peculiarities of exophytic liver hemangiomas and their radiological features, especially the essential diagnostic features on axial imaging. The various treatment options for symptomatic hemangiomas were explored, including the advantages of enucleation and why our patient could not benefit from it. Conclusion: Liver hemangiomas may require treatment when symptomatic. These lesions can be diagnosed with high-quality radiological imaging and surgically resected if indicated. Where imaging facilities are scarce, thorough patient evaluation and sound surgical decision-making are emphasised

Abstract No. 182 Transarterial bleomycin–Lipiodol embolization (B/LE) for symptomatic giant hepatic hemangioma: interim analysis

Hepatic hemangiomas are the most common benign tumors of the liver. Transarterial bleomycin–Lipiodol embolization (B/LE) is an effective alternative treatment for symptomatic hemangiomas. The purpose of this study is to investigate the long-term feasibility, efficacy, and safety of Transarterial bleomycin–Lipiodol embolization (B/LE) in the management of symptomatic giant liver hemangioma (GLH).

The Long-Term Outcome in a Cohort of 52 Patients With Symptomatic Intramedullary Spinal Cavernous Hemangioma After Microsurgery and Emergency Rescue Surgery.

BackgroundSurgery is the mainstay treatment for patients with symptomatic intramedullary spinal cavernous hemangioma (ISCH), however the time of surgical intervention remains controversial. In this study, we proposed emergency rescue surgery (ERS) for patients in deteriorative type. The prognostic factors of patients with ISCH after microsurgery and the clinical effect of ERS were analyzed.MethodsFrom January 2013 to November 2019, 52 patients with symptomatic ISCH treated by microsurgical treatment were collected, ranging in age from 17 to 66 years old (mean: 45.8 ± 13.5 years). The course of the disease ranged from 2 days to 20 years. Of 52 lesions, 17 lesions were in the cervical segment, 25 in the thoracic segment, and 10 in the lumbosacral segment; while seven cases were at the ventral surface, 25 cases at the dorsal surface, and 20 cases at the central spinal cord. The sagittal diameter ranged from 1 to 58 mm (median: 17.3 mm). The transverse diameter ratio ranged from 20 to 80% (median: 50.7%). Thirty-two patients were diagnosed as deteriorative type and 22 were treated by ERS.ResultsAt 12 months after surgery, all patients were followed up, and no residual or recurrence was found in all patients. Twenty-five patients (48.1%) showed spinal cord functional improvement after surgery; 25 (48.1%) had no functional change; 2 (3.8%) got worse. For deteriorative patients, ERS group had a significantly higher improvement rate than the non-ERS group (χ2 = 5.393, P = 0.02); For all 52 patients, the factors as a lesion at the ventral surface (Z = 10.453, P = 0.015), or lumbosacral segment (χ2 = 9.259, P = 0.010) and longer course of disease (Z = −2.021, P = 0.043) were potential risks in functional recovery in univariate analysis; and in multiple-factor analysis, the lesion at the lumbosacral segment (OR = 4.004, 95% CI: 1.341~11.961, P = 0.013) was the independent risk factors for the functional recovery.ConclusionsMicrosurgical resection is safe and effective for symptomatic ISCH. The ERS is an effective way to improve deteriorative patients' spinal cord function at long-term follow-up. The lesion at the lumbosacral segment is one of the poor prognostic factors.

Treatment and management of orbital tumors

There are various options for the conservative treatment of the most frequent orbital tumors. These can delay, complement or be superior to the surgical approach, which is often prone to complications. This article gives asummary of the possible treatment options for the most common orbital tumors in childhood and adulthood. Aliterature search was carried out and the possible treatment pathways are presented. 1.Frequent orbital tumors in childhood: asystemic treatment with noncardioselective beta blockers is the primary treatment for capillary orbital hemangiomas. In cases of no response, steroids, interferon alpha or cyclophosphamide are treatment options. Observation is apossible option for smaller dermoid cysts, in cases of progression excision can become necessary. Symptomatic optic nerve gliomas can also be observed and in cases of progression treated with chemotherapy, mTOR/MEK inhibitors or radiotherapy (children > 5years). Rhabdomyosarcomas are biopsied and subsequently treated by radiotherapy and chemotherapy. 2.Frequent orbital tumors in adulthood: asymptomatic cases of cavernous hemangiomas of the orbit can just be observed. Symptomatic hemangiomas can be surgically excised or treated with radiotherapy. For meningiomas of the optic nerve sheath radiotherapy is avery effective treatment. Surgical excision should be reserved for cases with no prognosis of visual acuity. There is also the option to treat with antiprogesterone. Orbital lymphomas with purely orbital involvement can be treated with radiotherapy, chemotherapy or the application of rituximab. There are now very effective conservative treatment options for many orbital tumors. In some cases asurgical procedure can be avoided and agood visual function can be retained.

Laparoscopic Management of Large Left Lobe Hepatic Hemangioma Presenting as Gastric Hemangioma on Radiology: A Case Report and Literature Review

Hepatic cavernous hemangiomas are the most common benign tumors of the liver. They can be found incidentally in the general population in up to 20% of the cases. On the other hand, gastric hemangioma is a very rare entity. These tumors account for only 0.05% of all gastrointestinal (GI) neoplasms. Hemangiomas have no malignant transformation potential. They are detected using CT-scan or MRI. Endoscopy can play a role in the differentiation of gastric from hepatic hemangiomas. Hepatic hemangioma can be associated with portal vein thrombosis as a mass effect resultant. Surgery is recommended for the treatment of symptomatic hemangiomas or giant ones (above 10cm). Laparoscopy is recommended for symptomatic hemangiomas less than 4cm or those who harbor a vascular pedicle. Here we present a case of a 50-year-old male presenting with a history of 1 month duration of epigastric pain and 5 kilograms of weight loss diagnosed on imaging studies with gastric hemangioma and partial portal vein thrombosis. Laparoscopic approach was adopted to deal with his condition. Intra-operatively, he was found to have hepatic hemangioma of around 10cm associated with complete atrophy of the left liver lobe. Decision was taken intra-operatively to carry a laparoscopic left hepatectomy regardless of all the challenges that pose laparoscopy in general for any hepatectomy. This decision was taken due to the presence of a vascular pedicle, which was clipped for hemostatic control.

Role of Robotic Surgery in the Management of Benign Hepatobiliary Diseases

Background: Recently robotic surgery has emerged as one of the most promising surgical advances. Despite its worldwide acceptance in many different surgical specialties, the use of robotic assistance in the field of hepatobiliary (HBP) surgery remains relatively unexplored. Our study presents single institution´s initial experience of robotic assisted surgery for treatment of benign hepatobiliary pathologies. Methods: A retrospective analysis of a prospectively maintained database on clinical outcomes was performed for 26 consecutive patients that underwent robotic assisted surgery for benign HBP disease at Rambam Medical Center during 2013-2015. Results: There were 26 robotic assisted surgical procedures performed for benign HBP pathologies during the study period. There were 3 anatomical robotic liver resections for symptomatic hemangiomas , 9 cases of giant liver cyst, 5 robotic assisted surgery for type I choledochal cyst, 2 case of benign (iatrogenic) common bile duct (CBD) stricture, 3 cases of robotic (CBD) exploration due to large intra choledochal stones and 6 cases of cholecystectomy for cholelithiasis. The median postoperative hospital stays for all procedures were 3.5 days (range 1-6 days). General morbidity (minor) was 2%. There was no mortality in our series. Conclusions: Robotic surgery is feasible and can be safely performed in patients with different benign HBP pathologies. Further evaluation with clinical trials is required to validate it´s real benefits.

Debulking of giant liver hemangiomas with severe symptoms: a case report

BackgroundThere are no previous reports of debulking of giant liver hemangioma. This report describes our experience with debulking surgery for a patient with bilateral giant liver hemangiomas with severe symptoms.Case presentationWe present a case of symptomatic giant liver hemangioma in a 41-year-old woman. She presented with abdominal pain and fullness at a local hospital and underwent trans-arterial embolization (TAE). TAE was not effective, and she was not able to walk a long distance. Giant liver hemangiomas, 30 cm and 15 cm in diameter, were located in the right liver and in the left lateral section, respectively, and normal liver parenchyma with tiny liver hemangiomas was present in segment 4. The liver function was normal. However, right hemi-hepatectomy with left lateral sectionectomy was considered to be risky according to the 3DCT volumetry. Therefore, we performed right hemi-hepatectomy in order to reduce her symptoms. The postoperative course was uneventful, and she was discharged on the 14th day after surgery. The abdominal fullness and abdominal pain disappeared immediately after surgery. The hemangiomas in the remnant liver, 15 cm in diameter, showed no change, and she is well without symptoms 7 years after surgery.ConclusionsDebulking surgery is one of the options for bilateral giant liver hemangiomas with severe symptoms.

Hepatic Hemangioma Treatment Using Microwave Coagulation Therapy—a Systematic Review

Hepatic hemangiomas (HH) are the most common benign liver tumors, with a prevalence ranging from 5 to 7.35% of all benign tumors of the liver. Most lesions occur to the fifth and sixth decades of life more frequently in females (female/male ratio = 5:1). Hepatic hemangiomas are composed of blood-filled cavities lined by a single layer of endothelial cells, fed by the hepatic artery. Hepatic hemangiomas are composed of blood-filled cavities lined by a single layer of endothelial cells, fed by the hepatic artery. The exact etiology of hepatic hemangiomas still is unclear though the genetic predisposition and estrogen in stimulating and/or contraceptive use have been proposed. A majority of hepatic hemangiomas are often asymptomatic and discovered incidentally. It is a slow-growing, so medical/surgical intervention is often not needed. However, the so-called giant cavernous hemangiomas (GCH) (greater than 5 cm in diameter) will usually develop symptoms and complications, which pose a higher risk of rupture that a radical intervention needs to be considered. Nowadays, hepatic hemangiomas therapy included surgical resection, intervention embolization, radio frequency ablation, microwave ablation, and drug therapy. There have been existing heated debates on the treatment strategies of hepatic hemangiomas for a long time because of the researchers lacked the evidence-based medical evidence data to analyze those treatment methods respectively. The present study is a comprehensive review of various treatments specially use of microwave ablation in large and symptomatic hepatic hemangiomas.

Preoperative Endovascular Embolisation of the Symptomatic Hemangioma in 7th Thoracic Vertebrae: Case Report

Abstract Although, as asymptomatic, they appear in about 10-12% of the worldwide population, vertebrae hemangiomas are symptomatic in about 0.9-1.2% of all the cases. We showed the case of the symptomatic hemangioma in the 7th thoracic vertebrae in 67 year old patient, that was successfully preoperative embolised. Magnetic resonance imaging (MRI) detected the tumor in the body of 7th vertebrae with mass effect on the anterior aspect of the spinal cord. Multidetector computed tomography (MDCT) imaging describes this tumor as hemangioma that is in the body of the Th7 vertebrae and in the both pedicules. We performed selective and supraselective spinal angiography which showed pathological vascularisation of the tumor, and then the tumor was embolised. The control angiography detected the reduction of the tumor blood vessels, as a sign of the successful embolisation. Ten days after embolisation, the patient went through corporectomia of the Th7 and the stabilization of the thoracic spine was performed. Intraoperative blood transfusion in our patient was 930 mL, while expected blood transfusion during the surgical intervention without preoperative embolisation is about 1600 mL. Method of choice in conditions with neurological compressive symptoms caused by vertebral hemangioma is surgery for the decompression of the nerve structures. Embolisation of aggressive vertebral hemangioma is recommended and preoperatively performed for the intraoperative hemorrhage reduction and decreasing of intraoperative complications.

Hemangioma: Recent Advances.

Hemangiomas are common benign vascular tumors that often present in childhood. Diagnosis is based on clinical history, physical examination, and, when unclear, assisted with ultrasound or MRI. While the majority are small, nonproblematic, and can be managed conservatively, some hemangiomas may be associated with underlying syndromes or concerning for visceral involvement. Symptomatic lesions may develop ulceration, bleeding, vision disturbances, functional limitations, or disfigurement. The ideal treatment for a symptomatic hemangioma is often multimodal and may vary depending on the size, location, and proximity to critical structures. Medical treatments include topical beta blockers, oral propranolol, or steroid injections. Surgical resection and laser therapies may be necessary to optimize long term outcomes.

Long-term Tumor Control With Radiotherapy for Symptomatic Hemangioma of a Vertebral Body.

Retrospective outcomes review. To analyze and report long-term outcomes in a cohort of patients treated with radiotherapy (RT) for symptomatic hemangioma of a vertebral body. Data are scarce on the rate of tumor control with long-term (>5 yr) follow-up after RT for symptomatic hemangioma of a vertebral body. We retrospectively reviewed the medical records of patients treated at our institution between 1971 and 2008 for symptomatic hemangioma of a vertebral body, updated their follow-up, analyzed complications, and calculated the tumor control rate. Tumor control by imaging was defined as no increase in tumor size on computed tomography (CT) or magnetic resonance (MR) scan. Clinical tumor control was defined as no symptoms of recurrent tumor. Ten patients were eligible for analysis. All patients had pain from visible hemangioma at the time of radiotherapy for which surgical resection or interventional radiology procedures were likely to result in high morbidity. Tumors were located in the lumbar (40%), thoracic (50%), or cervical (10%) areas of the spine. The mean radiotherapy dose delivered was 47 Gy.Mean imaging follow-up after completion of radiotherapy was 8.1 years; mean clinical follow-up was 21.2 years. The tumor control rate was 90% (9/10). One patient who may have developed a tumor recurrence had radiographic and clinical evidence of tumor progression 30 years after radiotherapy. The actuarial rate of tumor control was 100% at 5, 10, 20, and 25 years. There was no grade more than or equal to three treatment toxicities, no evidence of malignant transformation, and no evidence of second tumors in treatment area (with the possible exception of the one tumor recurrence). RT for symptomatic hemangioma of the spine provides long-term tumor control with a low risk of serious complications. Radiotherapy is a good option when surgery or an interventional radiology procedure is high-risk. Our preferred dose is 45 Gy at 1.8 Gy/fraction. 4.

Spine Tumor Epidemiology in Patients who Underwent Orthopaedic Surgery

Purpose of the study — to evaluate the frequency of spine tumors in patients who underwent orthopaedic treatment in a specialized hospital.Materials and methods. Ап patients treated in the Vreden Russian Research Institute of Traumatology and orthopedics (rniito) with spine tumor diagnosis were examined from 2000 till 2017. The data was obtained from medical histories. Patients’ distribution per gender, age, histological type and tumor location was evaluated.Results. 2023 patients were included into the study, where 1298 (64.3%) were female. Patients with secondary metastases prevailed (59% overall), including breast cancer (43.6%), renal carcinoma (18%) and lung cancer (10.7%). Among benign tumors (overall 18.7%) symptomatic hemangiomas prevailed (93.8%). Primary malignant tumors (total 10.2%) were represented mainly by multiple myeloma (54.2%) and plasmacytoma (14.6%). Intermediate tumors with local aggressive growth were observed rarely (overall 3.9%).Conclusion. Spine is affected mainly by secondary tumors, where metastases of breast, renal and lung cancer are observed most often. Benign symptomatic hemangiomas demonstrate a high prevalence. Primary malignant tumors are presented mainly by multiple myeloma. Other primary malignant tumors and tumors with local aggressive growth are observed rather rarely.

Benign Neoplasms of the Orbit

Benign orbital neoplasms comprise a wide spectrum of different entities. The origin of the tumours can be epithelial or mesenchymal. Epithelial neoplasms of the orbit originate from the lacrimal gland. The most important tumour is the pleomorphic adenoma, which should not be biopsied but resected in toto. The most common intraconal neoplasm in adults is the cavernous hemangioma. Symptomatic cavernous hemangiomas should be treated. The treatment of choice for most symptomatic benign neoplasms of the orbit is surgical resection. Suitable surgical approaches are anterior transconjunctival and lateral orbitotomy. Cryoextraction is a minimally invasive technique that is particularly suitable for cavernous hemangiomas.

Hemangiomatosis of the greater omentum – a case report

Cavernous hemangiomas are benign tumours of mesodermal origin. Even though various localizations of hemangioma have been described in the literature, its occurrence in the greater omentum is very rare. Only symptomatic hemangiomas are indicated for surgical treatment. There are case reports presenting resection or surgical removal of the greater omentum with hemangioma because of mechanical syndrome, consumption coagulopathy, bleeding, infection or suspicion of a malignancy. This article presents a case report of a patient operated on for a suspicion of carcinomatosis of the greater omentum. Histological examination found hemangiomatosis in the resected greater omentum.

Outcomes of ultrasound-guided percutaneous microwave ablation versus surgical resection for symptomatic large hepatic hemangiomas

Purpose: Microwave ablation (MWA) has become increasingly popular as a minimally invasive treatment for benign and malignant liver tumors. However, few studies have demonstrated the benefits and disadvantages of MWA compared to surgical resection (SR) for large hepatic hemangiomas. This study aimed to evaluate the safety and effectiveness of MWA compared to SR for large (5–10 cm) hepatic hemangiomas.Methods and materials: This retrospective comparative study included 112 patients with large, symptomatic hepatic hemangiomas who had been treated with MWA (n = 44) or SR (n = 68) and followed up for a median of 44 months using enhanced computed tomography (CT) or magnetic resonance imaging (MRI). Intraoperative information, postoperative recovery time, postoperative discomfort and complications and treatment effectiveness between groups were compared using a chi-square test or an independent t-test.Results: The operative time was significantly shorter (31.3 ± 21.76 versus 148.1 ± 59.3 min, p < .001) and the blood loss (10.2 ± 60.6 versus 227.9 ± 182.9 mL, p < .0001) and rate of prophylactic abdominal drainage [1 (2.3%) versus 57 (83.8%), p < .001] were significantly lower in the MWA group than in the SR group. Postoperative recovery of the MWA group in regard to indwelling catheter time, normal diet time, incision cicatrization time and hospital stay (p < .001) was significantly better than the SR group. However, no statistically significant difference in effectiveness was noted between the groups (p = .58).Conclusions: MWA may be as effective as SR, and potentially safer for treating large, symptomatic hepatic hemangiomas. To confirm our findings, large-sample, multicentered, randomized controlled trials are needed.

Robot-assisted enucleation of gigantic liver hemangiomas: Case series of 3 patients

IntroductionLiver hemangiomas are benign liver lesions that require surgical excision when large and symptomatic. Often, these tumors are removed through large anatomical resections which sacrifice more liver parenchyma than needed. Tumor enucleation, which takes advantage of a digitoclasia-like technique along the plane between the tumor pseudo-capsule and liver parenchyma, poses challenges when performed laparoscopically. We propose a parenchymal sparing, minimally invasive, robotic-assisted technique to remove liver hemangiomas. Presentation of casesThree male patients with symptomatic hemangiomas were treated in our center between 2015 and 2018. The lesions were located in segment II, III and segment IV-V respectively. Robotic-assisted hemangioma enucleation was accomplished successfully in all three patients. The procedures were performed with a parenchyma-sparing intent and a formal segmentectomy was not required. There were no conversions to open surgery. DiscussionThe robotic platform provides a powerful tool in the enucleation of liver hemangiomas. The enhanced vision and the superior suturing ability allow to develop safely the plane between the tumor pseudo-capsule and the liver parenchyma, with outstanding selective control of all the vascular supply and drainage encountered during the dissection. Furthermore, precision of the hilar dissection allows selective lobar or sectorial arterial control which helps minimize intraoperative bleeding. ConclusionIn our experience, robot-assisted enucleation of liver hemangiomas offers low morbidity, fast recovery, excellent cosmetic results, and it could become a therapeutic option when the location of the hemangioma allows this approach.

Resection of benign liver tumours: an analysis of 62 consecutive cases treated in an academic referral centre

Background: This study assessed the safety and outcome after resection of benign liver tumours (BLT) at a major referral centre. Methods: All patients with symptomatic BLTs who underwent resection were identified from a prospective database of 474 liver resections. Operative management, morbidity and mortality using the Accordion classification were analyzed. Results: 62 patients (56 women, 6 men, median age 45 years, range 17-82) underwent resection of symptomatic haemangiomas n=23 (37.1%), FNH n=19 (30.6%), biliary cystadenoma n=16 (25.8%) and hepatic adenomas n=4 (6.5%). A major resection was required in 25 patients (4 segments n=14, 3 segments n=11). 37 patients had 2 or fewer segments resected. Median operating time was 169 min (range 80-410). Median blood loss was 300ml (range 50-4500ml). An intra-operative blood transfusion was required in 6 patients. Median length of post-operative hospital stay was 7 days (range 4-32). Complications occurred in 11 patients. Accordion grades were 1 n=3, 2 n=4, 4 n=3, 6 n=1. 4 patients required re-operation (bleeding n=2, bile leak n=1, small bowel obstruction n=1). An elderly patient died following a postoperative cerebrovascular accident. Conclusion: Our data suggest that resections for BLTs can be performed safely with minimal blood loss and transfusion requirements. Despite the low postoperative mortality rate, the risk of postoperative complications emphasizes the need for careful selection of patients for resection.

Transarterial embolization of symptomatic giant liver hemangiomas

Background: In the present study, the clinical and radiologic results of transcatheter transarterial embolization (TAE) for the treatment of symptomatic giant cavernous hemangiomas of the liver were evaluated. Methods: Eleven patients (5 males, 6 females) with giant hemangiomas of the liver were treated by TAE. Hepatic angiography revealed hemangiomas up to 21.57 cm in diameter. Indications for TAE were abdominal pain (n=10) and rapid tumor enlargement (n=6). Two patients had Kasabach-Merritt syndrome (KMS). The percutaneous transarterial access was performed. The common femoral artery was puncture and hepatic artery was catheterized under fluoroscopic control. Embolization was performed with polyvinyl alcohol (PVA) particles of 500 - 900 micron Results: No treatment-related deaths were registered and morbidity was minimal. Post embolization syndrome (abdominal pain, fever, and leukocytosis) occurred in 7 patients within 1 – 4 days after TAE lasting for 3 - 7 days and was has been treated conservatively. Symptomatic improvement was documented in all patients. The haematologycal disorders normalized in both patients with KMS during 1 – 3 month after TAE. The mean size of the tumor did not show significant change on follow-up radiologic examinations. In two patients, the tumor significantly regressed in size after embolization. Two-year follow-up showed no recurrence of the clinical symptoms and hematological abnormalities in any patient. Conclusion: TAE is an effective procedure for the therapy of symptomatic hemangiomas