Vertebral Hemangioma Research Articles

Malignancy-related Hypercalcemia Caused by Metameric Cutaneous Metastasis of Parathyroid Hormone-related Protein-producing Bladder Carcinoma with Squamous Cell Differentiation: An Autopsy Case of Cobb Syndrome.

A 74-year-old woman was admitted with hypercalcemia and prolonged disturbance of consciousness. The left buttock to the anterior aspect of the left thigh was swollen and erythematous, with a collection of 1.0-cm large, firm, elastic nodules distributed in a zosteriform pattern in the L1-L4 region. Based on autopsy findings, a very rare case of Cobb syndrome was diagnosed due to a spinal vascular malformation at the Th12-L4 level and L5 vertebral hemangioma. Cobb syndrome-associated cutaneous metastasis extending along the same metamere was complicated by immunohistochemically proven parathyroid hormone-related protein-producing advanced bladder carcinoma in this case.

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.

Radiotherapy for benign diseases in Turkey: apatterns of care survey of the Turkish Society for Radiation Oncology (TROD 05-002).

We aimed to investigate the patterns of radiotherapy (RT) care in cases of benign diseases in Turkey. Aquestionnaire survey was sent to all radiation oncology (RO) departments in Turkey. The number of patients treated for benign disease between 2015 and 2020 was requested. Alist of benign conditions was given, and information on the number of patients per disease, single and total doses prescribed, weekly fractions, radiation type, energy, and device was requested. Of the 138 RO departments, 29(21%) responded. The data received concerned 15(52%) university, 10(34%) public, and four (14%) private hospitals. Atotal of 130,846 patients were treated with RT in these departments. Of these patients, 6346 (4.85%) were treated for benign conditions. The most common benign diseases treated with RT were meningioma (35%), plantar fasciitis (19%), schwannoma (16%), arteriovenous malformation (11%), and pituitary adenoma (7%). Most centers performed RT for paraganglioma, heterotopic ossification, vertebral hemangioma, and Graves' ophthalmopathy, but none treated arthrosis. Wide variations were observed across the departments. Radiosurgery for intracranial pathologies was performed intensively in four centers. By contrast, RT for plantar fasciitis was predominantly treated in five centers, one of which had more than 1000 patients. The ratio of patients who underwent RT for benign diseases in Turkey among all patients who underwent RT was 4.85%. The common pattern of RT in 72% of patients was radiosurgery for intracranial benign diseases, followed by low-dose RT for plantar fasciitis in 19%.

Advancements in poly(methyl Methacrylate) bone cement for enhanced osteoconductivity and mechanical properties in vertebroplasty: A comprehensive review.

The evolution of polymethyl methacrylate (PMMA) based bone cement (BC) from plexiglass to a biomaterial has revolutionized the joint and vertebral arthroplasties field. This widely used grouting material possesses exceptional properties for medical applications, including excellent biocompatibility, impressive mechanical strength, and favorable handling characteristics. PMMA-based BC is preferred in challenging conditions such as osteoporotic vertebral compression fractures, scoliosis, vertebral hemangiomas, spinal metastases, and myelomas, where it is crucial in withstanding stress. This review aims to comprehensively analyze the available reports and guide further research toward enhanced formulations of vertebral BC, focusing on its osteoconductive and mechanical properties. Furthermore, the review emphasizes the significant impact of BC's mechanical properties and osteoconductivity on the success and longevity of vertebroplasty procedures.

Multidisciplinary management of invasive vertebral hemangioma: the role of different neurointervention modalities—a retrospective study

BackgroundCatastrophic intraoperative bleeding is a major complication of surgical removal of invasive vertebral hemangioma. Interventional neuroradiology techniques could be more useful tools to manage such hemorrhagic lesions.ResultsRetrospective analysis of cases of invasive vertebral hemangioma revealed 17 cases treated at the Alexandria University School of Medicine from 2006 to 2020. The study included 52.9% of males with a mean age of 38.4 ± 18.6 years old. All patients reported local and sometimes radicular pain; 64.7% exhibited progressive neurological deficits. Imaging revealed thoracic spine affection in 11 cases, lumbar vertebral in four cases, and cervical vertebra in two cases. Vertebral involvement occurred in 10 cases and paravertebral extension in 13 cases. Neurointervention modalities included transarterial embolization followed by corpectomy and fixation (one case with C4 lesion), direct surgery with corpectomy and anterior fixation (one case with C7 lesion), vertebroplasty alone (four cases), vertebroplasty with fixation (seven cases), and direct transpedicular alcohol injection with immediate devascularization and necrosis of the vascular channels inside the lesions (six cases). The alcohol injection use ranged from 4 to 10 ml in each pedicle. All patients did well during the follow-period post-intervention. The neurological deficits improved over six months. All patients showed improved Nurick grade regardless of the intervention (preoperative mean 2.7 ± 1.9 vs. postoperative mean 1.1 ± 1.3, p value 0.0001). Two patients were completely paraplegic, but with intact deep sensation, they improved dramatically and can walk unsupported post-intervention.ConclusionsVertebral hemangioma can present in an invasive manner that necessitates intervention. Preoperative embolization, alcohol injection, or vertebroplasty are helpful methods to decrease intraoperative catastrophic hemorrhage. Alcohol injection is cost-effective with immediate devascularization of the lesion. The extensive 360 surgery utilization can be decreased with the use of alcohol and vertebroplasty. More cases are needed to validate these conclusions.

Unmasking the great imitators-noninfectious conditions masquerading as spinal tuberculosis in a developing country: A single-center case series analysis

The diagnosis of spinal tuberculosis often relies on clinical, radiological, and laboratory findings, particularly in resource-constrained settings. However, numerous noninfectious conditions exhibit similar clinical and radiological features to spinal tuberculosis, leading to potential misdiagnosis in the absence of microbiological or histopathological confirmation. This study aims to present a case series from a developing country, highlighting noninfectious conditions that mimic spinal tuberculosis. A retrospective analysis was conducted on hospital records and imaging of patients diagnosed with spinal tuberculosis, lacking microbiological or histopathological evidence, and unresponsive to empirical antitubercular treatment. Patients displaying noninfectious conditions resembling spinal tuberculosis upon further investigation were included. Clinical and radiological findings of these patients were thoroughly analyzed. Among a total of 23 patients observed over a 6-year period (2015-2020), various noninfectious conditions were identified as mimickers of spinal tuberculosis. These conditions included vertebral body haemangioma, ankylosing spondylitis (with or without Andersson lesion), rheumatoid pannus, osteoid osteoma, cystic hygroma, multiple myeloma, vertebral metastasis, malignant small round-cell tumor, pancreatic pseudocyst, esophageal duplication cyst, Modic changes in degenerative disc disease, Paget's disease, and psoas hematoma. Noninfectious spinal conditions can masquerade as spinal tuberculosis, underscoring the importance of obtaining a definitive tissue diagnosis before initiating antitubercular treatment. Particular attention should be given to features such as central lesions and the absence of soft tissue involvement in suspected cases of spinal tuberculosis, warranting a careful reconsideration of the diagnosis.

Typical vertebral hemangioma with aggressive transformation

Typical vertebral hemangioma with aggressive transformation

Rare case of vertebral hemangioma causing spinal compression - diagnosis and treatment: Space Occupying Lesion (SOL) study

Background. This case report highlights the importance of accurate diagnosis and treatment for intramedullary spinal cord hemangioma, which is a rare condition that can present with common symptoms of various spinal cord pathologies. The report recommends decompression laminectomy as the appropriate intervention for this condition. This report adds to the existing clinical literature on intramedullary spinal cord hemangioma and can assist clinicians in the diagnosis and treatment of similar cases. Case report. The patient is a 30-year-old female who complained of left leg heaviness, cramps, numbness, and urinary incontinence. MRI revealed a suspected intradural intramedullary lesion, as high as VTh5, suspected to be ependymoma or astrocytoma. The patient underwent decompressive laminectomy on thoracalis vertebra 5-7 and spinal cord mass with hemorrhage and calcification components was observed on post-operative Spinal CT Angiography. The mass was found to have a feeder artery from spinal branches of the left right a. intercostalis at T5 level and spinal branches of the left a. intercostalis at T6 level. Thoracolumbar spondylosis was also observed. Conclusion. The clinical impact of vertebral hemangioma lies in its potential to cause neurological deficits due to spinal cord or nerve root compression. Early diagnosis and treatment through imaging modalities such as MRI and surgical intervention, such as laminectomy, can alleviate symptoms and prevent disability or mortality. However, careful consideration of the patient’s clinical history, imaging findings, and neurological status is necessary for accurate diagnosis and appropriate management.

Transpedicular Onyx embolization of a thoracic hemangioma with robotic assistance: illustrative case.

Hemangiomas are common benign vascular lesions that rarely present with pain and neurological deficits. Symptomatic lesions are often treated with endovascular embolization. However, transarterial embolization can be technically challenging depending on the size and caliber of the vessels. Moreover, embolization can result in osteonecrosis and vertebral collapse. Here the authors report the first case of a T10 vertebral hemangioma treated with transpedicular Onyx embolization aided by a robotic platform that guided pedicle cannulation and Craig needle placement. An intravenous catheter was attached to the needle and dimethylsulfoxide was infused, followed by Onyx under real-time fluoroscopy. Repeat angiography demonstrated significantly reduced contrast opacification of the vertebral body without compromise of the segmental artery. A T9-11 pedicle screw fixation was performed to optimize long-term stability. The patient's symptoms improved and was stable at the 6-month follow-up. Transpedicular embolization of vertebral hemangiomas can be performed successfully under robotic navigation guidance, avoiding complications seen with the intra-arterial approach and allowing for simultaneous pedicle screw fixation to prevent collapse and delayed kyphotic deformity. During the same procedure, a biopsy specimen can be collected for pathology. This technique can help to alleviate patient symptoms while avoiding complications associated with transarterial embolization or open resection.

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.

Incidental findings detected on magnetic resonance imaging scans of the cervical, thoracic and lumbar spine of patients prediagnosed with discopathy

Objective: To determine the frequency and types of incidental findings on magnetic resonance imaging (MRI) scans of the cervical,
 thoracic, and lumbar spine in patients with intervertebral discopathy.
 Patients and Methods: This retrospective study included 1000 patients (513 females and 487 males, with a mean age of 50.5 years)
 with clinically suspected intervertebral discopathy who underwent MRI. Any abnormal findings and congenital anomalies/anatomical
 variations unrelated to the primary complaint were referred to as incidental findings. Frequency distributions of the assessed imaging
 characteristics were calculated.
 Results: Of the 1000 patients, 192 (19.2%) patients were presented with incidental findings. The positive findings in the thoracic spine
 (26%) were higher than those in the lumbar (19.8%) and cervical spine (13.7%). The study found vertebral haemangioma to be the
 most common finding, followed by Schmorl’s nodes in the thoracic and lumbar spine. Thyroid nodules constituted the most common
 finding in the cervical spine, followed by vertebral haemangioma. Renal cysts in the thoracic and lumbar spine and thyroid nodules in
 the cervical spine were the most frequent extraspinal findings.
 Conclusion: Incidental findings are commonly detected during MRI examination of intervertebral discs, and most are benign findings.
 However, incidental findings including clinically essential findings can alter the patient’s treatment or affect the patient’s life. Therefore,
 it is crucial to systematically evaluate MRIs without focusing solely on the spine and report incidental findings detected on MRI.

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.

P128 Management of parturients with a vertebral body haemangioma: an OAA approved national survey

P128 Management of parturients with a vertebral body haemangioma: an OAA approved national survey

Unusual False Positive on 99mTc-Tektrotyd Scintigraphy Mimicking Bone Metastasis.

Somatostatin receptor scintigraphy is a key diagnostic tool in the initial staging and therapeutic evaluation of neuroendocrine tumors. Its specificity can be compromised by the presence of false positives. We illustrate here the case of a vertebral hemangioma detected on 99mTc-Tektrotyd scintigraphy as an incidental finding in a 34-year-old man referred for the staging of a well-differentiated neuroendocrine tumor of the ampulla of Vater (Fig.1).

Imaging features of intraosseous hemangiomas: beyond the mobile spine and calvarium.

Describe imaging features of intraosseous hemangiomas located outside of the mobile spine and calvarium. Imaging and medical records were retrospectively reviewed for cases of intraosseous hemangiomas located outside of the calvarium and mobile spine. Evaluation included patient demographics, histologic confirmation, and imaging characteristics. Thirty-six patients were included (25 F, 11M; mean age 54 ± 17years, range 10-84years) with 37 total lesions (70% axial and 30% appendicular skeleton). Mixed lytic and sclerotic features were identified on 83-85% radiographs and CTs. Amorphous increased density mimicking osteoid matrix was present on 38-45% radiographs and CTs. Classic honeycomb or radial pattern was identified on 45% of CTs. Osseous expansion and cortical permeation were common features. CT identified periosteal reaction in 24% of lesions. All hemangiomas had heterogeneous MRI signal and most moderately or avidly enhanced. Intralesional fat was identified on 78% MRIs, often as a minor component and only detected on 24% of CTs. A soft tissue mass was present on 52% of MRIs. FDG PET/CT mean SUVmax of 3.2 ± 0.6 (range 1.9-5.0). Lesional FDG activity relative to background marrow was increased in 75% of lesions. Lesions with cortical permeation had higher metabolic activity versus those without (3.5 ± 0.7 versus 2.2 ± 0.3, p = 0.041). Intraosseous hemangiomas outside of the mobile spine and calvarium demonstrate more aggressive imaging features compared to vertebral hemangiomas, including cortical permeation, soft tissue mass, amorphous increased density mimicking osteoid matrix, and increased FDG activity.

Vertebral hemangioma - the current radiation therapy perspective.

Vertebral hemangiomas are benign tumors of the spine, most often detected incidentally and on other instances, when signs and symptoms of the disease arise. About 10% of the population are affected worldwide with a female to male ratio of 2:1. The majority of these cases are asymptomatic and no intervention is generally required. Less often, back pain and neurological deficit may occur. Such hemangiomas are termed aggressive by the Enneking staging and warrant treatment. In this review, staging and diagnostics are discussed in detail followed by treatment options. Treatment options entail Surgical intervention, Percutaneous ethanol injection, radiofrequency ablation and Radiation Therapy. There are no set guidelines on preference or order of the treatment options. Further, in this review, studies favouring Radiation therapy regimes and their outcomes are elaborated.

5P Long term outcome of surgical management for vertebral hemangioma presenting with myelopathy

5P Long term outcome of surgical management for vertebral hemangioma presenting with myelopathy

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.

Direct intralesional n-butyl-cyanoacrylate embolization for intractable vertebral hemangioma bleeding: a salvage technique. Illustrative case.

Surgical resection of vertebral hemangiomas in the setting of cord compression can be technically difficult and has the potential for life-threatening hemorrhage. The authors report a case of intraoperative direct intralesional n-butyl-cyanoacrylate embolization for intractable vertebral hemangioma bleeding. A 53-year-old woman presented for repeat surgery of a residual vertebral hemangioma after a previous debulking, laminectomy, and fixation that were without problems with bleeding. The second surgery was complicated by intractable hemorrhage. Bleeding was controlled with direct intralesional n-butyl-cyanoacrylate embolization after fluoroscopy without accompanying endovascular embolization. Aggressive vertebral hemangiomas should ideally be managed in centers where transarterial embolization is available. If such centers are not available or there is still intractable intraoperative bleeding despite preoperative embolization, direct intralesional embolization may be considered as a potential salvage technique.