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Takeda C, Tanishima S, Ohuchi Y, Mihara T, Yamaga K, Yoshida M, Nagashima H. Sclerotherapy for Aggressive Vertebral Hemangioma with Severe Bone Destruction: A 5-Year Analysis. Spine Surg Relat Res 2024; 8:548-551. [PMID: 39399455 PMCID: PMC11464831 DOI: 10.22603/ssrr.2024-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/20/2024] [Indexed: 10/15/2024] Open
Affiliation(s)
- Chikako Takeda
- Department of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Shinji Tanishima
- Department of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yasufumi Ohuchi
- Department of Radiology, Matsue Red Cross Hospital, Matsue, Japan
| | - Tokumitsu Mihara
- Department of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kensaku Yamaga
- Department of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Masaki Yoshida
- Department of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hideki Nagashima
- Department of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
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2
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Timilsina K, Shrestha S, Bhatta OP, Paudel S, Lakhey RB, Pokharel RK. Atypical Aggressive Hemangioma of Thoracic Vertebrae Associated With Thoracic Myelopathy-A Case Report and Review of the Literature. Case Rep Orthop 2024; 2024:2307950. [PMID: 39165484 PMCID: PMC11335424 DOI: 10.1155/2024/2307950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 07/05/2024] [Accepted: 08/02/2024] [Indexed: 08/22/2024] Open
Abstract
Aggressive thoracic hemangiomas are rare, benign tumors that extend into the spinal canal and cause neurological symptoms. Delayed diagnosis and treatment, due to a paucity of literature on optimal treatment strategies, can increase morbidity. This case report describes a 19-year-old male patient with aggressive thoracic hemangioma who presented with upper back pain and progressive weakness of the lower extremities. The patient underwent preoperative embolization and sclerotherapy, followed by decompression, posterior instrumentation, and stabilization. The final diagnosis was confirmed by biopsy, and there was a significant improvement in neurology after the surgical intervention. The diagnosis of rare lesions, such as aggressive hemangiomas, requires a high level of clinical suspicion and the assistance of imaging modalities in patients with features of compressive myelopathy. A combination of endovascular and surgical approaches can lead to optimal outcomes.
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Affiliation(s)
| | - Sandesh Shrestha
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | - Sushil Paudel
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Rajesh Bahadur Lakhey
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Rohit Kumar Pokharel
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Teaching Hospital, Kathmandu, Nepal
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3
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Kato K, Teferi N, Challa M, Eschbacher K, Yamaguchi S. Vertebral hemangiomas: a review on diagnosis and management. J Orthop Surg Res 2024; 19:310. [PMID: 38789994 PMCID: PMC11127296 DOI: 10.1186/s13018-024-04799-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/18/2024] [Indexed: 05/26/2024] Open
Abstract
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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Affiliation(s)
- Kyle Kato
- University of Iowa Carver, College of Medicine, Iowa City, IA, USA.
| | - Nahom Teferi
- Department of Neurosurgery, University of Iowa Carver, College of Medicine, Iowa City, IA, USA
| | - Meron Challa
- University of Iowa Carver, College of Medicine, Iowa City, IA, USA
| | - Kathryn Eschbacher
- Department of Pathology, University of Iowa Carver, College of Medicine,, Iowa City, IA, USA
| | - Satoshi Yamaguchi
- Department of Neurosurgery, University of Iowa Carver, College of Medicine, Iowa City, IA, USA
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Lofrese G, Cultrera F, Ricciardi L, Visani J, Tosatto L, Ruggiero M, Haznedari N, Menetti F. Preoperative elastoplasty of aggressive vertebral hemangiomas in elderly patients: a new strategy for reducing intraoperative bleeding and complications. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1921-1929. [PMID: 38491218 DOI: 10.1007/s00586-024-08201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE Preoperative elastoplasty could be an alternative strategy for treating aggressive vertebral hemangiomas (VHs) in frail patients needing for spinal cord decompression, combining the advantages of embolization and vertebroplasty. METHODS Three elderly patients with spinal cord compression from thoracic aggressive VHs underwent XperCT-guided percutaneous injection of silicone (VK100), filling the whole affected vertebra, followed by a decompressive laminectomy. At 12-months follow-up no recurrences, vertebral collapse or segmental kyphosis were noted at the CT scans, with patients reporting an improvement of preoperative neurological deficits, VAS and Smiley-Webster pain scale (SWPS) parameters. RESULTS With its elastic modulus, non-exothermic hardening, and lower viscosity than PMMA, VK100 allowed a preoperative augmentation of the affected vertebral body, pedicles, and laminae without complications, with a controlled silicone delivery even in part of VH's epidural components thanks to XperCT-guidance. CONCLUSION When facing highly bony erosive VH encroaching the spinal canal, VK100 combines the advantages of embolization and vertebroplasty especially in elderly patients, permeating the whole VH's angioarchitecture, significantly reducing tumor.
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Affiliation(s)
- Giorgio Lofrese
- Neurosurgery Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Francesco Cultrera
- Neurosurgery Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Luca Ricciardi
- Neurosurgery Division, Sapienza University, Via di Grottarossa 1035, Rome, Italy.
| | - Jacopo Visani
- Neurosurgery Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Luigino Tosatto
- Neurosurgery Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Maria Ruggiero
- Neuroradiology Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Nicolò Haznedari
- Neuroradiology Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Federico Menetti
- Neuroradiology Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
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5
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Swaminathan G, Jonathan GE, Mani SA, Keshava SN, Moses V, Prabhu K. Surgical strategies in the management of aggressive spinal haemangiomas: Retrospective case series with literature review and a practical treatment algorithm. BRAIN & SPINE 2023; 4:102736. [PMID: 38510623 PMCID: PMC10951693 DOI: 10.1016/j.bas.2023.102736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/21/2023] [Accepted: 12/11/2023] [Indexed: 03/22/2024]
Abstract
Purpose We studied the clinico-radiological features and treatment outcomes of patients with aggressive spinal haemangiomas. Methods We undertook a retrospective review of 24 patients with aggressive spinal haemangiomas managed at our centre from 2004 to 2016. The cohort was divided into two groups. Group1 included patients managed from 2004 to 2009 while Group 2 was those treated between 2010 and 2016. Clinicoradiological features and treatment outcomes were studied. Results Back pain (24/24) and myelopathy (18/24) were the most common presenting complaints. Over 80% (20/24) of patients, had involvement of the thoracic spine and more than 50% (13/24) had severe spasticity, being Nurick grade 4&5 at presentation. The various treatment modalities used were laminectomy with or without instrumented posterior fusion (10/24), corpectomy with instrumented fusion (10/24) and alcohol injection alone (4/24). Patients who were treated with surgery had significant clinical improvement at follow-up in both groups. Patients who underwent alcohol injection did not have any improvement in symptoms at follow-up. There was a change in our strategy in the later part of the series from a two staged anterior and posterior approach to a single staged posterior-only approach to address vertebral body disease with preoperative angioembolization. Conclusion Haemangiomas are benign lesions with locally aggressive behavior in some cases. Results of conservative approaches such as alcohol injection in management of these lesions are discouraging. Aggressive surgical decompression combined with preoperative adjuncts such as angioembolization with or without stabilization reduces intra operative blood loss and results in good neurological recovery even in patients with severe myelopathy.
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Affiliation(s)
- Ganesh Swaminathan
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | | | | | | | - Vinu Moses
- Department of Radiodiagnosis, Christian Medical College, Vellore, India
| | - Krishna Prabhu
- Department of Neurological Sciences, Christian Medical College, Vellore, India
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Teferi N, Chowdhury AJ, Mehdi Z, Challa M, Eschbacher K, Bathla G, Hitchon P. Surgical management of symptomatic vertebral hemangiomas: a single institution experience and literature review. Spine J 2023; 23:1243-1254. [PMID: 37059306 DOI: 10.1016/j.spinee.2023.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/13/2023] [Accepted: 04/07/2023] [Indexed: 04/16/2023]
Abstract
Vertebral hemangiomas (VHs), formed from a vascular proliferation in bone marrow spaces limited by bone trabeculae, are the most common benign tumors of the spine. While most VHs remain clinically quiescent and often only require surveillance, rarely they may cause symptoms. They may exhibit active behaviors, including rapid proliferation, extending beyond the vertebral body, and invading the paravertebral and/or epidural space with possible compression of the spinal cord and/or nerve roots ("aggressive" VHs). An extensive list of treatment modalities is currently available, but the role of techniques such as embolization, radiotherapy, and vertebroplasty as adjuvants to surgery has not yet been elucidated. There exists a need to succinctly summarize the treatments and associated outcomes to guide VH treatment plans. In this review article, a single institution's experience in the management of symptomatic VHs is summarized along with a review of the available literature on their clinical presentation and management options, followed by a proposal of a management algorithm.
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Affiliation(s)
- Nahom Teferi
- Department of Neurosurgery, College of Medicine, University of Iowa Carver, 200 Hawkins Drive, Iowa City, Iowa 52242 USA.
| | - A J Chowdhury
- College of Medicine, University of Iowa Carver, 200 Hawkins Drive, Iowa City, Iowa 52242 USA
| | - Zain Mehdi
- College of Medicine, University of Iowa Carver, 200 Hawkins Drive, Iowa City, Iowa 52242 USA
| | - Meron Challa
- College of Medicine, University of Iowa Carver, 200 Hawkins Drive, Iowa City, Iowa 52242 USA
| | - Kathryn Eschbacher
- Department of Pathology, College of Medicine, University of Iowa Carver, 200 Hawkins Drive, Iowa City, Iowa 52242 USA
| | - Girish Bathla
- Department of Radiology, Mayo clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Patrick Hitchon
- Department of Neurosurgery, College of Medicine, University of Iowa Carver, 200 Hawkins Drive, Iowa City, Iowa 52242 USA
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Mousavi SR, Akbari S, Rasekhi A, Kazeminezhad A, Motlagh MAS, Taherpour S. A less aggressive approach to the treatment of aggressive vertebral hemangioma of the thoracic spine: A case report and literature review. Int J Surg Case Rep 2023; 105:108027. [PMID: 36965444 PMCID: PMC10073888 DOI: 10.1016/j.ijscr.2023.108027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/07/2023] [Accepted: 03/21/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Different treatments are available for aggressive vertebral hemangioma [AVH], but a consensus is yet to be reached about the best therapeutic approach. PURPOSE To explore the possibility that selecting a less aggressive therapeutic approach for AVH decreases the intraoperative and postoperative complications while providing similar clinical, radiographic, and disease-free survival results to more aggressive therapeutic methods. STUDY We report the case of an AVH of the thoracic spine at the T5 level, treated via perioperative selective arterial embolization plus surgical decompression via laminectomy and reconstruction with polymethylmethacrylate (PMMA) vertebroplasty. PATIENT The patient was a 17-year-old male referred to our center with the chief complaint of low back pain from two months earlier, without any response to analgesics, and with neurologic manifestations as paraparesis (one month) and progressive sphincter problems (one week). Upon imaging, the impression was an aggressive spinal tumor with cord compression. OUTCOME MEASURES After the operation, the patient's pain immediately improved, and his neurologic manifestations progressively improved. RESULTS The patient started walking with help about three weeks after the operation. Roughly six months later, he achieved a complete neurological recovery. At present, about two years following the operation, he has a normal life without any neurological problems. CONCLUSION Based on our experience with AVH, the selection of less aggressive therapeutic approaches such as perioperative diagnostic angiography and selective embolization decrease the intraoperative and postoperative complications like intraoperative bleeding and neurological injury, while achieving similar clinical, radiographic, and disease-free survival outcomes to more aggressive therapeutic methods.
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Affiliation(s)
- Seyed Reza Mousavi
- Department of Neurosurgery, Shiraz University of medical science, Shiraz, Iran; Shiraz Neuroscience Research Center, Shiraz University of medical science, Shiraz, Iran
| | - Somayeh Akbari
- Histomorphometry and Stereology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Rasekhi
- Department of Radiology, Shiraz University of medical science, Shiraz, Iran
| | - Ali Kazeminezhad
- Department of Neurosurgery, Peymanieh Hospital, Trauma Research Center, Jahrom University, Iran
| | | | - Sanaz Taherpour
- Department of Neurosurgery, Shiraz University of medical science, Shiraz, Iran.
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8
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Carlos-Escalante JA, Paz-López ÁA, Cacho-Díaz B, Pacheco-Cuellar G, Reyes-Soto G, Wegman-Ostrosky T. Primary Benign Tumors of the Spinal Canal. World Neurosurg 2022; 164:178-198. [PMID: 35552036 DOI: 10.1016/j.wneu.2022.04.135] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 11/23/2022]
Abstract
Benign tumors that grow in the spinal canal are heterogeneous neoplasms with low incidence; from these, meningiomas and nerve sheath tumors (neurofibromas and schwannomas) account for 60%-70% of all primary spinal tumors. Benign spinal canal tumors provoke nonspecific clinical manifestations, mostly related to the affected level of the spinal cord. These tumors present a challenge for the patient and healthcare professionals, for they are often difficult to diagnose and the high frequency of posttreatment complications. In this review, we describe the epidemiology, risk factors, clinical features, diagnosis, histopathology, molecular biology, and treatment of extramedullary benign meningiomas, osteoid osteomas, osteoblastomas, aneurysmal bone cysts, osteochondromas, neurofibromas, giant cell tumors of the bone, eosinophilic granulomas, hemangiomas, lipomas, and schwannomas located in the spine, as well as possible future targets that could lead to an improvement in their management.
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Affiliation(s)
| | | | | | | | - Gervith Reyes-Soto
- Neuro-oncology Unit, Instituto Nacional de Cancerología, México City, Mexico
| | - Talia Wegman-Ostrosky
- Subdirection of basic research, Instituto Nacional de Cancerología, México City, Mexico.
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Facchini G, Parmeggiani A, Peta G, Martella C, Gasbarrini A, Evangelisti G, Miceli M, Rossi G. The role of percutaneous transarterial embolization in the management of spinal bone tumors: a literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2839-2851. [PMID: 34415449 DOI: 10.1007/s00586-021-06963-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Spinal bone tumors include a heterogeneous broad of primary or metastatic lesions that may present as incidental findings or manifest with painful symptoms and pathological fractures. Optimal management of spine bone lesions is often difficult and treatment algorithms are usually solidly based on surgery. We aimed to evaluate the contribution of trans-arterial embolization in this field, with particular attention to the procedure efficacy, technical difficulties and complications. METHODS We present a literature review on the role of trans-arterial embolization in the management of spinal bone tumors, both primary and metastatic, evaluating its contribution as preoperative treatment, palliative procedure and standalone curative strategy. RESULTS Trans-arterial embolization provides an important contribution to reducing surgery hemorrhagic risks, offering a better visualization of the operating field, and possibly increasing tumor susceptibility to chemotherapy or radiation therapy. Nonetheless, it plays an important part in pain palliation, with the unquestionable advantage of being easily repeatable in case of necessity. Its curative role as a standalone therapy is still subject of debate, and at the present time, satisfactory results have been recorded only in the treatment of aneurysmal bone cysts. CONCLUSION Percutaneous trans-arterial embolization has established as a highly useful minimally invasive procedure in the management of spinal bone lesions, particularly as adjuvant preoperative therapy and palliative treatment.
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Affiliation(s)
- Giancarlo Facchini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Anna Parmeggiani
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1, 40136, Bologna, Italy. .,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | - Giuliano Peta
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Claudia Martella
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1, 40136, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Gasbarrini
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gisberto Evangelisti
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Giuseppe Rossi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1, 40136, Bologna, Italy
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10
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Shen Z, Zhang D, Li G, Huang D, Qiu Y, Xie C, Zhang X, Wang X, Liu Y. Clinical Characteristics, Classification, and Management of Adult Nasopharyngolaryngeal Hemangioma. Laryngoscope 2021; 131:2724-2728. [PMID: 34160868 DOI: 10.1002/lary.29703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/03/2021] [Accepted: 06/14/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS To analyze the clinical features, classification, and treatment of adult nasopharyngolaryngeal hemangioma (ANPLH). STUDY DESIGN Retrospective study. METHODS From February 2009 to May 2020, 101 patients with ANPLH were reviewed and analyzed. RESULTS Symptoms of ANPLH were frequently displayed as abnormal pharyngeal sensation and functional defection. According to lesion location, ANPLH was divided into five categories including nasopharyngeal, oropharyngeal, hypopharyngeal, laryngeal, and mixed types. The mixed type constitutes the highest portion, and the nasopharyngeal type is the least in our cohort. Most lesions could resect through natural cavity under endoscopy. Patients with mixed lesions had a higher rate of postoperative recurrence and planned multiple surgeries. Acceptable but not severe intraoperative and postoperative complications occurred in our patient cohort. CONCLUSIONS Patients with ANPLH are always symptomatic and even functional defective, which can be classified into five categories based on lesion location. For these patients, endoscopic surgery through natural cavity is recommended to remove lesions with fewer complications and favorable clinical outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Zhe Shen
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Diekuo Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Guo Li
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Donghai Huang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Yuanzheng Qiu
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Changning Xie
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Xin Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Xingwei Wang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Yong Liu
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Xiangya Hospital, Central South University, Changsha, People's Republic of China
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11
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Roscop C, Gariel F, Kieser DC, Bouyer B, Gille O, Marnat G, Berge J. Doughnut vertebroplasty for circumferential aggressive vertebral hemangiomas. J Neurointerv Surg 2021; 14:neurintsurg-2020-016785. [PMID: 33632885 DOI: 10.1136/neurintsurg-2020-016785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND To assess the feasibility, safety and efficacy of a percutaneous doughnut vertebroplasty of circumferential aggressive vertebral hemangiomas (VHs). METHODS We retrospectively reviewed our prospectively collected database of patients with VHs treated with vertebroplasty between January 2009 and January 2018. Patient demographics, clinical presentations and procedural details were recorded. All patients underwent preoperative computed tomography (CT) and magnetic resonance imaging (MRI). All vertebroplasties were performed under conscious sedation in the prone position, predominantly using biplane fluoroscopic guidance. A clinical and imaging evaluation (early CT scan and MRI) as well as a final follow-up clinical assessment was performed. RESULTS Twenty-two patients with aggressive VHs who underwent circumferential vertebroplasty with cementation of the entire vertebral body and at least one posterior hemi-arch were included (six males, mean age 53 years). At 3 months follow-up, nine patients (41%) had complete, 11 (50%) had partial and two (9%) had no resolution of pain. Nine of 14 patients had a decrease in venous swelling on MRI. No complications were observed. Five patients (23%) underwent adjunctive surgery within 1 year for persistence or worsening of neurological symptoms. Clinical and radiographic improvements were maintained to final follow-up. CONCLUSIONS Doughnut vertebroplasty offers a mini-invasive, safe and effective treatment of aggressive circumferential VHs. This technique improves pain in over 90% of patients as well as a reduction in radicular and neurological symptoms associated with a tendency to regression of the compressive epidural venous component of these lesions.
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Affiliation(s)
- Cecile Roscop
- The Spine Institute, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Florent Gariel
- Interventional Neuroradiology, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - David Christopher Kieser
- Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Benjamin Bouyer
- The Spine Institute, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Olivier Gille
- The Spine Institute, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Gaultier Marnat
- Interventional Neuroradiology, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France.,Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Jerome Berge
- Interventional Neuroradiology, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
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Chopra H, Hoffman H, Richardson TE, Galgano MA. Surgical management of symptomatic vertebral hemangiomas: A case report and literature review. Surg Neurol Int 2021; 12:56. [PMID: 33654559 PMCID: PMC7911040 DOI: 10.25259/sni_752_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/18/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Vertebral hemangiomas (VHs) are common benign tumors that only rarely become symptomatic. There is a paucity of data regarding their surgical management and outcomes. Here, we reported a case involving an aggressive cervical VH, discussed its surgical management and outcomes, and reviewed the literature. Methods: We assessed the clinical, radiological, and surgical outcomes for a patient with an aggressive cervical VH. We also performed a systematic review of the literature according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to describe surgical outcomes for symptomatic VH. Results: A total of 154 studies including 535 patients with VH were included in the study. The majority of patients were female (62.8%), the average age was 43 years, and the thoracic spine was most commonly involved (80.6%). Utilizing Odom’s criteria, outcomes were excellent in 81.7% (95% CI 73.2–90.2) of cases. For those presenting with myelopathy (P = 0.045) or focal neurological deficits (P = 0.018), outcomes were less likely to be excellent. Preoperative embolization was not associated with excellent outcome (P = 0.328). Conclusion: Surgical outcomes for VH are predominantly favorable, but aggressive VHs have the potential to cause significant residual postoperative neurological morbidity.
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Affiliation(s)
- Harman Chopra
- Department of Neurosurgery, SUNY Upstate, Syracuse, New York, United States
| | - Haydn Hoffman
- Department of Neurosurgery, SUNY Upstate, Syracuse, New York, United States
| | | | - Michael A Galgano
- Department of Neurosurgery, SUNY Upstate, Syracuse, New York, United States
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