The role of radiation therapy in vertebral hemangiomas without neurological signs

Guedea, F.; Majó, Joan; Guardia, E.; Canals, E.; Craven-Bartle, Jordi

doi:10.1007/bf02484415

Cited by 29 publications

(10 citation statements)

References 12 publications

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“…Only one patient had a complete response (100%), good response (> 50%) was seen in two patients and partial response (< 50%) in three (2). However, this therapy carries the risk of radiation-induced secondary sarcomas or the development of radionecrosis (13). Embolization requires the use of a medullar angiography in order to ensure that the hemangioma is not vascularised by a spinal artery (14).…”

Section: Discussionmentioning

confidence: 99%

Management of Cement Vertebroplasty in the Treatment of Vertebral Hemangioma

Boschi

Pogorelić²,

Gulan³

et al. 2011

Scand J Surg

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Results: in all the patients a successful outcome has been observed with a complete resolution of pain symptom. extravertebral vascular cement leakage has been observed in 3 patients, without any clinical radicular syndrome onset due to the epidural diffusion. clinical and radiological follow-up showed stability of the treatment and absence of pain in all patients.Conclusion: percutaneous treatment with vertebroplasty for symptomatic vertebral hemangiomas is a valuable, less-invasive, and a quick method that allows a complete and enduring resolution of the painful vertebral symptoms without findings of the vertebral body's fracture.

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Section: Discussionmentioning

confidence: 99%

Management of Cement Vertebroplasty in the Treatment of Vertebral Hemangioma

Boschi

Pogorelić²,

Gulan³

et al. 2011

Scand J Surg

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“…We found 17 previous studies (3,7,20,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) on the use of radiotherapy in vertebral hemangioma for the years 1926 through 2004. An analysis of the 228 patients in this body of research treated solely with radiotherapy showed that complete pain relief was obtained in 54 percent of the patients, and partial response was obtained in 32 percent.…”

Section: Resultsmentioning

confidence: 84%

Symptomatic Vertebral Hemangioma: Results of Radiotherapy

Aksu

Korcum

2008

Journal of Musculoskeletal Pain

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Objectives: To evaluate the efticacy of radiotherapy in treating vertebral hemangioma and review ihe literature.Methods: Radiotherapy was administered to 38 patients with medically lefractory pain or to patients who hud a hemangioma larger Ihanone-lhird of lhe vcrlebral body. All patients received a total dose of 40 Gy in 20 Iractions. The most frequently involved region was the lumbar spine [.'S perccnl] followed by the thoracic region |2I percent]. Fourteen patients [37 percent] had multilevel involvement. Twenty-one patients also had several musculoskeletal disorders in the neighboring vertebrae.Results: A complete response was achieved in 22 patients [!S8 pcrccnl]. partial response in 10 patients |26 percent|, and no response in 6 palienls 116 percent]. In patients with musculoskelcial disorders, complete, partial, and no response rates were 43 percent, 33 percent, and 24 percent, respectively. In patients wilh only a vertebral hemangioma, these same rates were 76.4 percent, 17.6 percent, and 6 percent, respectively; this difference was statistically significant \P -0.031. When sex, symptom duration, number of involved vertebrae, and location and size of the hemangioma were examined, there was no statislicaliy significant relationship between ihe.sc variables and the effect t)f radiotherapy on pain management.Conclusions: This large .series involved 38 patients treated with a homogenous dose of radiation and fractionation schema. Radiotherapy is a relatively safe, effective, and tt)lerable treatment for symptomatic vertebral hemangit)mas. Owing to lhe varying causes of pain for patients with musculoskeletal disorders with vertebral hemangioma, pain management may be an issue.

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“…Radiation therapy is reported in patients with involvement of multiple vertebral levels [3,8]. The recommended dose is 2 Gy per day for several weeks up to a total of 30-40 Gy [11]. Patients with neurologic symptoms should undergo laminectomy before radiation therapy initiation, because the edema secondary to radiation therapy can worsen the symptoms [21].…”

Section: Discussionmentioning

confidence: 99%

Acute spinal cord compression due to intraspinal bleeding from a vertebral hemangioma: two case-reports

Castel

Lazennec

Chiras

et al. 1999

European Spine Journal

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IntroductionVertebral hemangioma is a common, benign, isolated lesion [10] that is usually discovered fortuitously on radiographs taken for another reason. Some patients, however, have chronic back pain and/or neurologic symptoms due to spinal cord or nerve root compromise. Spinal cord compromise is usually due to slowly progressive compression secondary to concentric narrowing of the spinal canal [19]. Although plain radiographs can show suggestive changes in a vertebral body, consisting of coarse trabeculae arranged in a honeycomb configuration, MRI is required in most cases and allows evaluation of the degree of vertebral canal stenosis [9]. A vertebral hemangioma can produce acute spinal cord compression during the last 3 months of pregnancy [1, 2,17,27] or after a trivial trauma [12]. To avoid missing the diagnosis, investigations should be selected rationally, especially as the neurologic lesions sometimes require emergency surgical treatment. Other problems include selection of the best release method, determination of the role and extent of fixation, and evaluation of the need for complementary vertebroplasty. We illustrate these problems with two reports of patients who required emergency surgery for acute spinal cord compression. Case reportsCase 1A 27-year-old woman was 7 months pregnant when she sought medical advice for recent onset of rapidly worsening weakness in both legs responsible for difficulty in walking. Her medical history was unremarkable, and she denied any precipitating event.The physical examination disclosed a pyramidal syndrome in both lower limbs, with muscle weakness reflected by a muscle strength grade of 3, and sensory loss up to the umbilicus, indicating spinal cord compression at the level of T10.Plain radiographs disclosed a corduroy appearance of T8 with no vertebral collapse or pedicular lysis.An MRI study was done on an emergency basis to evaluate this picture of acute spinal cord compression. Changes typical of intraspinal bleeding from a hemangioma of T8 were seen. The body, pedicles, and neural arch of T8 were manifest as low signal on T1-weighted images and high signal on T2-weighted images, consistent with a type 1 vertebral hemangioma, the most frequent type in the classification developed by the French Society for Neurosurgery [19].After a cesarean section, decompression of the spinal cord was achieved by laminectomy of T7 and T8, which was performed without prior embolization. Internal fixation was then performed from T6 to T10 using Domino Howmedica plates screwed into the pedicles.Motor function and touch sensation promptly returned to normal, whereas nociception and deep sensation remained partially impaired.Abstract Vertebral hemangiomas can cause acute spinal cord compression either after a minor trauma or during the last 3 months of pregnancy. Failure to recognize the lesion can lead to potentially serious treatment delays. An emergency MRI scan usually establishes the diagnosis of vertebral hemangioma responsible for spinal cord compression requiring laminect...

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The role of radiation therapy in vertebral hemangiomas without neurological signs

Abstract: We describe 5 patients with vertebral haemangiomas treated by radiotherapy of 30-40 Gy, 2-3 Gy/day. The management of vertebral haemangiomas is discussed.

Cited by 29 publications

References 12 publications

Management of Cement Vertebroplasty in the Treatment of Vertebral Hemangioma

Management of Cement Vertebroplasty in the Treatment of Vertebral Hemangioma

Symptomatic Vertebral Hemangioma: Results of Radiotherapy

Acute spinal cord compression due to intraspinal bleeding from a vertebral hemangioma: two case-reports

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