Symptomatic vertebral hemangiomas: a report of four cases

Baker, Nancy; Greenspan, Adam; Neuwirth, Michael G.

doi:10.1007/bf00355106

Cited by 45 publications

(10 citation statements)

References 5 publications

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“…52 In the 1970s it was suggested that angiography could be used not only to confirm the diagnosis but also to perform endovascular embolization of the feeding arteries in order to reduce vascularity of the tumor and decrease blood loss during surgery. 8,19,22,37,50,53,59,73 The benefits of embolization were confirmed in a systematic review that included 51 patients with aggressive vertebral hemangiomas. This study found that in the group that received preoperative embolization, blood loss was significantly less than in the group that did not (980 vs 1629 ml, respectively).…”

Section: Endovascular Embolizationmentioning

confidence: 90%

Surgical treatment of aggressive vertebral hemangiomas

Vasudeva

John

Groff

2016

FOC

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OBJECTIVE Vertebral hemangiomas are common tumors that are benign and generally asymptomatic. Occasionally these lesions can exhibit aggressive features such as bony expansion and erosion into the epidural space resulting in neurological symptoms. Surgery is often recommended in these cases, especially if symptoms are severe or rapidly progressive. Some surgeons perform decompression alone, others perform gross-total resection, while others perform en bloc resection. Radiation, embolization, vertebroplasty, and ethanol injection have also been used in combination with surgery. Despite the variety of available treatment options, the optimal management strategy is unclear because aggressive vertebral hemangiomas are uncommon lesions, making it difficult to perform large trials. For this reason, the authors chose instead to report their institutional experience along with a comprehensive review of the literature. METHODS A departmental database was searched for patients with a pathological diagnosis of “hemangioma” between 2008 and 2015. Medical records were reviewed to identify patients with aggressive vertebral hemangiomas, and these cases were reviewed in detail. RESULTS Five patients were identified who underwent surgery for treatment of aggressive vertebral hemangiomas during the specified time period. There were 2 lumbar and 3 thoracic lesions. One patient underwent en bloc spondylectomy, 2 patients had piecemeal gross-total resection, and the remaining 2 had subtotal tumor resection. Intraoperative vertebroplasty was used in 3 cases to augment the anterior column or to obliterate residual tumor. Adjuvant radiation was used in 1 case where there was residual tumor as well. The patient who underwent en bloc spondylectomy experienced several postoperative complications requiring additional medical care and reoperation. At an average follow-up of 31 months (range 3–65 months), no patient had any recurrence of disease and all were clinically asymptomatic, except the patient who underwent en bloc resection who continued to have back pain. CONCLUSIONS Gross-total resection or subtotal resection in combination with vertebroplasty or adjuvant radiation therapy to treat residual tumor seems sufficient in the treatment of aggressive vertebral hemangiomas. En bloc resection appears to provide a similar oncological benefit, but it carries higher morbidity to the patient.

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Section: Endovascular Embolizationmentioning

confidence: 90%

Surgical treatment of aggressive vertebral hemangiomas

Vasudeva

John

Groff

2016

FOC

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“…Magnetic resonance imaging (MRI) is useful, especially in differentiating a hemangioma from other tumors; it is valuable in pre-operative planning and it can provide additional information regarding the aggressiveness of the lesion [14,27]. Spinal angiography is a useful diagnostic tool, especially in pre-operative planning, since it can demonstrate both the vascularity of the lesion and the origin of the feeding vessels [1,11,17,30].…”

Section: Discussionmentioning

confidence: 99%

“…Observation, radiation or embolization [10,12,24,31,44] and surgical decompression [13,16,20,24,30,32,36,37] are the various stages of management, and they are employed according to the patient's situation. Surgical decompression must be performed when there is a progressive neurologic decline [1,30,32]. The greatest risk is excessive blood loss during the resection of the lesion, or postoperative epidural hematoma [13,16,20,24,37].…”

Section: Discussionmentioning

confidence: 99%

Pain pattern in multiple vertebral hemangiomas involving non-adjacent levels: report of two cases

Korres

Karachalios

Roidis

et al. 2000

European Spine Journal

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IntroductionHemangioma is a benign tumor consisting of blood vessels. There are two types: generalized and localized. In the generalized type there is involvement of multiple organs such as the liver, skin and bone [7]. Localized hemangiomas are the most common. In the skeleton, the most common site is the spine, followed by the skull and pelvis. Hemangiomas are often asymptomatic and discovered accidentally, but they may cause back pain or spinal cord compression in some cases. Radiographic and CT evidence of the hemangioma are characteristic. Multiple lesions of the spine are rather uncommon. Management of the patient depends on the severity of the symptoms, and may be either conservative or surgical.We present the cases of two patients with multiple hemangiomas of the spine involving multiple non-adjacent vertebrae and we comment on the possible clinical significance of their presentation. Case reports Case 1A 68-year-old man initially presented at the outpatient clinic because of persistent low back-pain. Radiographs revealed hemangiomas of the L3 and L4 vertebrae (Fig. 1). Conventional radiographs of the upper spine were normal. The patient was treated by conservative means. He was given non-steroidal anti-inflammatory drugs (NSAID) and a course of physiotherapy, and he was soon symptom free. At a follow up examination 1 year later, he was symptom free and was discharged. He was advised to attend annual follow-up examinations but did not.The patient came back to the clinic 15 years later complaining of suffering acute back pain localized in the area of T8-T10 during the previous 3 months. Common pain-killers gave him no relief. On examination, there was no evidence of neurologic involvement,

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“…Decompressive surgery with or without postoperative irradiation has been the therapy of choice for lesions causing spinal-cord compression (1 [3][4][5][6][7][8][9][10][11][12][13][14][15]. In this series, the patient with paraplegia who was treated with laminectomy followed by radiotherapy improved completely.…”

Section: Discussionmentioning

confidence: 99%