Aggressive spinal haemangiomas: imaging correlates to clinical presentation with analysis of treatment algorithm and clinical outcomes

Cloran, Francis J.; Pukenas, Bryan; Loevner, Laurie A.; Aquino, Christopher; Schuster, James M.; Mohan, Suyash

doi:10.1259/bjr.20140771

Cited by 47 publications

(36 citation statements)

References 18 publications

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“…Few previous studies have investigated the effectiveness of radiotherapy in the treatment of aggressive vertebral hemangioma, and the outcome of radiation treatment [ 6 , 15 – 23 ]. There is also controversy regarding whether radiation therapy can induce malignant transformation in benign vertebral hemangioma [ 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

The Role of Radiotherapy and Surgery in the Management of Aggressive Vertebral Hemangioma: A Retrospective Study of 20 Patients

et al. 2018

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BackgroundVertebral hemangioma is usually a benign and asymptomatic tumor of blood vessels, but can be aggressive (symptomatic) with expansion, pain, and spinal cord compression. The aim of this study was to review the effects of radiotherapy, surgery, and other treatment approaches in patients with aggressive vertebral hemangioma.Material/MethodsRetrospective clinical review included 20 patients who underwent radiotherapy as their first-line treatment for aggressive vertebral hemangioma with mild or slowly developing neurological deficit. External radiation was divided into 20–25 fractions with a total dose of 40–50 Gy. Minimum clinical follow-up after treatment was 20 months.ResultsThe 20 patients included eight men and 12 women (mean age, 46.6 years), with aggressive vertebral hemangioma located in the cervical, thoracic, and lumbar vertebrae in four, 14, and two patients, respectively. Following radiotherapy treatment, 65.0% of patients (13/20) were symptom-free, without recurrence or malignant transformation at the time of last clinical follow-up (average, 75.2 months). Due to minor post-radiation vertebral re-ossification, two of the 13 patients who were initially symptom-free after radiotherapy requested percutaneous vertebroplasty. A further seven patients required surgery after radiotherapy, due to increasing neurological deficit in three patients, and persistent neurological deficit in four patients. At the last follow-up (average, 63.6 months), six patients were symptom-free, and one patient still had slight residual symptoms.ConclusionsRadiotherapy was a safe and effective treatment choice for aggressive vertebral hemangioma, but in case with severe spinal cord compression and neurological deficit, surgical intervention was required.

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Section: Introductionmentioning

confidence: 99%

The Role of Radiotherapy and Surgery in the Management of Aggressive Vertebral Hemangioma: A Retrospective Study of 20 Patients

et al. 2018

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“…Currently, the reported treatments for vertebral hemangiomas include radiotherapy [17], interventional embolization [18], alcohol ablation [19,20], vertebroplasty [21], and surgery [2,3,8]. Cloran et al [4] believed that physicians should attend to symptomatic hemangiomas and that multimodal treatments should be used for patients with S3 hemangiomas, which includes preoperative interventional embolization, spinal canal decompression or en bloc. We started thinking about an absorbable gelatin sponge to reduce the amount of bleeding from 2013.…”

Section: Discussionmentioning

confidence: 99%

“…These lesions are usually localized to one of three anatomical locations: on the periosteal surface, within the cortex, or within the medullary canal [3]. On imaging, the spinal vertebral body typically manifests as fence-, grid-, and honeycomb-like changes to the vertebral body [4,5]. Currently, a vertebral hemangioma is classified using the following three stages of the Enneking system: (1) during latency, the tumor is restricted within the spinal compartment (Enneking stage 1; S1); (2) during the active stage, the tumor is contained within the spinal compartment and is accompanied by clinical symptoms (Enneking stage 2; S2); and (3) during the aggressive stage, the tumor expands out of the spinal compartment and is accompanied by clinical symptoms (Enneking stage 3; S3) [1].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative injection of absorbable gelatin sponge (AGS) mixed with cement followed by spinal decompression to treat elderly with vertebral hemangiomas

Lan

Huang

2020

BMC Musculoskelet Disord

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Background: Elderly patients with vertebral hemangiomas are rare and might require surgery. Thus, the choice of surgery for these lesions remains controversial because of the rarity of these lesions. This study aimed to analyze the clinical efficacy of the intraoperative injection of absorbable gelatin sponge mixed with cement followed by spinal decompression to treat the elderly with typical vertebral hemangiomas. The risk factors for hemangioma recurrence were investigated through a literature review. Methods: We retrospectively analyzed 13 patients with typical aggressive hemangiomas between January 2009 and January 2016. Of these patients, 7 were treated with spinal decompression combined with intraoperative vertebroplasty (Group A), and 6 patients were treated with decompression with intraoperative vertebroplasty and absorbable gelatin sponge (Group B). The general data and perioperative data of the patients were compared. Patients were followed up for at least 3 years, and postoperative complications and recurrence rates were recorded and compared. Results: All patients had typical aggressive hemangiomas. The average age of all patients was 64.4 ± 3.3 years. The preoperative data did not differ significantly between the two groups (P > 0.05). The blood loss of groups A and B was 707.1 ± 109.7 ml and 416.7 ± 103.3 ml, respectively (P = 0.003) (P = 0.003), and the average surgery durations were 222 ± 47.8 min and 162 ± 30.2 min, respectively (P = 0.022). The average follow-up duration was 62 ± 19 months, and no cases of recurrence were found at the final follow-up assessment. Conclusions: Multimodal treatment significantly alleviated the clinical symptoms of elderly patients with typical aggressive vertebral hemangiomas. Intraoperative absorbable gelatin sponge injection is a safe and effective way to reduce blood loss and surgery duration.

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“…Several different treatment strategies have been proposed including surgery (e.g., decompressive laminectomy, spondylectomy, arterial ligation), radiotherapy, transarterial embolization, percutaneous ethanol instillation (i.e., sclerotherapy), vertebroplasty, which was reported for the first time by a French team in the late 1980s, 42 and various combinations of all these treatments. 35,[43][44][45][46][47][48][49] Follow-up Follow-up is substantially similar to that applied for benign bone tumors such as OO and OB. Early (1-month) and mid-to long-term (6 and !…”

Section: Therapeutic Strategymentioning

confidence: 99%

French Multidisciplinary Approach for the Treatment of MSK Tumors

Cazzato

Garnon

Marini

et al. 2020

Semin Musculoskelet Radiol

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Several interventional treatments have recently been integrated into the therapeutic armamentarium available for the treatment of bone tumors. In some scenarios (e.g., osteoid osteoma), interventional treatments represent the sole and definitive applied treatment. Due to the absence of widely shared protocols and the complex multivariate scenarios underlying the clinical presentation of the remaining bone tumors including metastases, therapeutic strategies derived from a multidisciplinary tumor board are essential to provide effective treatments tailored to each patient. In the present review, we present the multidisciplinary therapeutic strategies commonly adopted for the most frequent bone tumors.

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Aggressive spinal haemangiomas: imaging correlates to clinical presentation with analysis of treatment algorithm and clinical outcomes

Abstract: Aggressive haemangiomas are rare, but knowledge of their imaging features and treatment strategies enhances the radiologist's role in their management.

Cited by 47 publications

References 18 publications

The Role of Radiotherapy and Surgery in the Management of Aggressive Vertebral Hemangioma: A Retrospective Study of 20 Patients

The Role of Radiotherapy and Surgery in the Management of Aggressive Vertebral Hemangioma: A Retrospective Study of 20 Patients

Intraoperative injection of absorbable gelatin sponge (AGS) mixed with cement followed by spinal decompression to treat elderly with vertebral hemangiomas

French Multidisciplinary Approach for the Treatment of MSK Tumors

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