Management of pediatric single-level vertebral hemangiomas presenting with myelopathy by three-pronged approach (ethanol embolization, laminectomy, and instrumentation): a single-institute experience

Singh, Pankaj Kumar; Chandra, P. Sarat; Vaghani, Gaurang; Savarkar, Dattaraj Paramanand; Garg, Kanwaljeet; Kumar, Rajender; Kale, Shashant Sharad; Sharma, Bhawani Shankar

doi:10.1007/s00381-015-2941-x

Cited by 18 publications

(5 citation statements)

References 46 publications

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“…Singh et al reported 7 cases (5 females and 2 males) in 2015. The patients received an ethanol injection via bilateral pedicles under fluoroscopic guidance, followed by posterior decompression and fixation surgery [ 20 ]. The mean age of the participants was 14 years (range: 10–17 years).…”

Section: Resultsmentioning

confidence: 99%

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

Tonosu¹,

Yamaguchi²,

Higashikawa³

et al. 2023

JCM

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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.

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Section: Resultsmentioning

confidence: 99%

“…Curettage could be acceptable because hemangioma is a benign tumor. On the contrary, the results of two case series with surgery indicated that curettage of the tumor is not mandatory [ 19 , 20 ]. During their follow-up periods of 45.3 and 47.6 months, respectively, neither recurrence nor delayed compression fractures were described.…”

Section: Discussionmentioning

confidence: 99%

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

Tonosu¹,

Yamaguchi²,

Higashikawa³

et al. 2023

JCM

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show abstract

“…Several approaches to effective treatment of these tumors have been more recently developed. 12,18 Although these tumors carry a high risk of bleeding, outcomes of treatment have generally been reported as favorable. 8 In our case, the patient progressively regained neurological function, with the ability to stand on postoperative day 2.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Vertebral Hemangioma of the Posterior Elements Sharing Blood Supply with a Radiculomedullary Artery

2018

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Vertebral hemangiomas are common lesions usually restricted to the vertebral body. They are characterized by proliferation of endothelial cells and subsequent expansion of vascular spaces within the bone. These lesions are usually clinically silent and are discovered incidentally. Only rarely are vertebral hemangiomas symptomatic. Here, we present the case of a 68-year-old female with an aggressive hemangioma causing neurologic deficit. The lesion was localized within the posterior spinal elements, with no involvement of the vertebral body. Transarterial embolization was deemed unsafe due to the close proximity of a prominent radiculomedullary artery. The patient was treated with posterior decompression at T4-T6.

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“…The last option for percutaneous intervention is transarterial embolization of feeding vessels using particulate agents [1]. It has been used as a preoperative adjunct therapy with surgery to reduce blood loss as well as a primary treatment for VHs alone or in conjunction with vertebroplasty [41,[62][63][64]. In a series of 26 patients, Premat et al demonstrated embolization combined with vertebroplasty was safe and effective in treating pain associated with aggressive VHs but was less effective in resolving motor deficits [65].…”

Section: Percutaneous Techniquesmentioning

confidence: 99%

“…In a series of 26 patients, Premat et al demonstrated embolization combined with vertebroplasty was safe and effective in treating pain associated with aggressive VHs but was less effective in resolving motor deficits [65]. The primary role for embolization in the treatment of compressive VHs is preoperative adjunct therapy to reduce the risk of procedural bleeding [62].…”

Section: Percutaneous Techniquesmentioning

confidence: 99%

Vertebral hemangiomas: a review on diagnosis and management

Kato,

Teferi,

Challa

et al. 2024

J Orthop Surg Res

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Background Vertebral hemangiomas (VHs) are the most common benign tumors of the spinal column and are often encountered incidentally during routine spinal imaging. Methods A retrospective review of the inpatient and outpatient hospital records at our institution was performed for the diagnosis of VHs from January 2005 to September 2023. Search filters included “vertebral hemangioma,” "back pain,” “weakness,” “radiculopathy,” and “focal neurological deficits.” Radiographic evaluation of these patients included plain X-rays, CT, and MRI. Following confirmation of a diagnosis of VH, these images were used to generate the figures used in this manuscript. Moreover, an extensive literature search was conducted using PubMed for the literature review portion of the manuscript. Result VHs are benign vascular proliferations that cause remodeling of bony trabeculae in the vertebral body of the spinal column. Horizontal trabeculae deteriorate leading to thickening of vertical trabeculae which causes a striated appearance on sagittal magnetic resonance imaging (MRI) and computed tomography (CT), “Corduroy sign,” and a punctuated appearance on axial imaging, “Polka dot sign.” These findings are seen in “typical vertebral hemangiomas” due to a low vascular-to-fat ratio of the lesion. Contrarily, atypical vertebral hemangiomas may or may not demonstrate the “Corduroy” or “Polka-dot” signs due to lower amounts of fat and a higher vascular component. Atypical vertebral hemangiomas often mimic other neoplastic pathologies, making diagnosis challenging. Although most VHs are asymptomatic, aggressive vertebral hemangiomas can present with neurologic sequelae such as myelopathy and radiculopathy due to nerve root and/or spinal cord compression. Asymptomatic vertebral hemangiomas do not require therapy, and there are many treatment options for vertebral hemangiomas causing pain, radiculopathy, and/or myelopathy. Surgery (corpectomy, laminectomy), percutaneous techniques (vertebroplasty, sclerotherapy, embolization), and radiotherapy can be used in combination or isolation as appropriate. Specific treatment options depend on the lesion's size/location and the extent of neural element compression. There is no consensus on the optimal treatment plan for symptomatic vertebral hemangioma patients, although management algorithms have been proposed. Conclusion While typical vertebral hemangioma diagnosis is relatively straightforward, the differential diagnosis is broad for atypical and aggressive lesions. There is an ongoing debate as to the best approach for managing symptomatic cases, however, surgical resection is often considered first line treatment for patients with neurologic deficit.

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Management of pediatric single-level vertebral hemangiomas presenting with myelopathy by three-pronged approach (ethanol embolization, laminectomy, and instrumentation): a single-institute experience

Cited by 18 publications

References 46 publications

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

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

Symptomatic Vertebral Hemangioma of the Posterior Elements Sharing Blood Supply with a Radiculomedullary Artery

Vertebral hemangiomas: a review on diagnosis and management

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