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

Abstract

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. Overview of Literature: 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. Methods: 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. Results: 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). Conclusions: 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.

Revision total en bloc spondylectomy for a recurrent aggressive vertebral haemangioma of the thoracic spine causing progressive thoracic myelopathy with segmental kyphosis

“…[ 1 , 3 ]. The thoracic spine is the predilected region, a characteristic shared with our case [ 4 , 9 ]. In contrast, our patient’s primary symptoms and the index operation occurred during childhood, a rarity in this context [ 4 , 5 ].…”

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

“… No Vasudeva et al [ 59 ] 2016 05 8–43 months 4 preoperative embolizations; 1 en bloc spondylectomy; 2 piecemeal gross-total resections; 2 subtotal resections; 3 intraoperative VPs; and 1 adjuvant radiotherapy CSF leak, wound infection DVT, and hardware failure in 1 case Gajaseni et al [ 55 ] 2017 01 12 months PE and total T10 resection No Ben Wang et al [ 45 ] 2018 20 20 months Role of Radiotherapy and surgery Not mentioned Prabhuraj et al [ 64 ] 2019 05 12 months Surgery + perioperative glue embolization. No Ji et al [ 56 ] 2019 07 Mean 51.4 months Total en bloc spondylectomy No Wei hong Xu et al [ 67 ] 2020 13 Average 62 = 19 months Decompression + Vertebroplasty + Gelatin sponge + Cement (n = 6) Decompression + Intraoperative vertebroplasty (n = 7) No Yu et al [ 57 ] 2020 06 25.8 months Single-fraction SBRT Dose was 18 Gy (range, 13–20) No Makoto Handa et al [ 60 ] 2020 15 128.4 = 88.6 months Total en bloc spondylectomy (n = 10) Piecemeal total tumor excision(n = 1) Revision procedure 2 weeks after ineffective laminectomy (n = 4) No Xu D et al [ 65 ] 2021 51 Average 5.3 = 2.1 years 16 Embolization + Decompression 19 Decompression + vertebroplasty 16 Embolisation + Decompression + Vertebroplasty No Guna et al [ ...…”

Paravertebral Nerve Block for Procedural Pain in Percutaneous Vertebroplasty

“…S ince Galibert et al 1 first reported in 1984 among patients with an aggressive vertebral angioma, percutaneous vertebroplasty (PVP) has become the standard treatment for painful thoracolumbar osteoporotic vertebral compression fractures (OVCFs), OVCF osteonecrosis, vertebral pathologic fracture, and aggressive vertebral hemangioma, despite remaining a controversial procedure. [2][3][4][5][6] However, a substantial proportion of patients undergo PVP without an adequate intraoperative analgesic procedure, and procedural pain during PVP often tends to be overlooked in clinical practice. In addition, these procedures may result in painful experiences for patients.…”