1
|
Raj A, Abraham A, Raja Navaneethan P, Mathew V. Spinal haemangioma with cauda equina syndrome in pregnancy. BMJ Case Rep 2022; 15:e250306. [PMID: 35760508 PMCID: PMC9237868 DOI: 10.1136/bcr-2022-250306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The true incidence of haemangiomas, which are the most common benign tumours in the spine, is not known as they are most often asymptomatic and are detected at autopsy. It can become symptomatic due to the haemodynamic and hormonal changes in pregnancy which cause sudden expansion of the lesion. In this paper, we present a case of a woman in her 30s, primigravida at 31 weeks' gestation with acute urinary retention and neurological features suggestive of cauda equina syndrome. Imaging confirmed the diagnosis of vertebral haemangioma involving T12 vertebra encroaching the posterior dural space and abutting the cord. She underwent surgical excision of the haemangioma with complete recovery of neurological symptoms on postoperative follow-up.
Collapse
Affiliation(s)
- Arathy Raj
- Department of Obstetrics and Gynecology, Unit III, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Anuja Abraham
- Department of Obstetrics and Gynecology, Unit III, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Preethi Raja Navaneethan
- Department of Obstetrics and Gynecology, Unit III, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Vivek Mathew
- Department of Neurosciences, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| |
Collapse
|
2
|
Ridzoňová L, Fedičová M, Andráš T, Urdzík P, Gdovinová Z. Lower-limb progressive paraparesis management and diagnosis overview in a pregnant woman with vertebral haemangioma. WOMEN'S HEALTH 2022; 18:17455057221099018. [PMID: 35574823 PMCID: PMC9109165 DOI: 10.1177/17455057221099018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vertebral haemangioma is a benign vascular tumour mostly seen in the thoracic region of the spine. Spinal haemangiomas are usually asymptomatic and are discovered incidentally. In a few patients, however, aggressive vertebral haemangiomas can cause local pain, radicular pain or neurologic deficits, which result from neural compression. The aetiology of the origin is unclear and is probably multifactorial. Hormonal and biological changes in pregnant women can lead to accelerated vascular growth of haemangioma. In our report, we present the case of a pregnant patient who was diagnosed with an aggressive vertebral haemangioma that further led to progressive paraparesis. We had to take the fact that she was pregnant into account in the diagnostic procedure, in the choice of examination method and also in the method of therapy. The goal of this case report is threefold: (1) provide an overview of the possible methods of management, specifically imaging, which will aid in diagnosis and based on that, (2) determining the appropriate therapy and (3) review the risks and benefits of each will be presented when choosing individual approaches.
Collapse
Affiliation(s)
- Lívia Ridzoňová
- Department of Neurology, Louis Pasteur University Hospital, Kosice, Slovakia
| | - Miriam Fedičová
- Department of Neurology, Louis Pasteur University Hospital, Kosice, Slovakia
| | - Tomaš Andráš
- Department of Neurosurgery, Louis Pasteur University Hospital, Kosice, Slovakia
| | - Peter Urdzík
- Department of Gynaecology and Obstetrics, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovakia
| | - Zuzana Gdovinová
- Department of Neurology, Louis Pasteur University Hospital, Kosice, Slovakia
- Department of Neurology, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovakia
| |
Collapse
|
3
|
Zhao L, Jiang Y, Wang Y, Bai Y, Sun Y, Li Y. Spinal Epidural Cavernous Hemangiomas: A Clinical Series of 9 Cases and Literature Review. Front Oncol 2021; 11:572313. [PMID: 33816222 PMCID: PMC8010302 DOI: 10.3389/fonc.2021.572313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Spinal epidural cavernous hemangiomas are very rare vascular lesions and are, therefore, seldom reported and easily misdiagnosed. Herein, we present a series of 9 cases with spinal epidural cavernous hemangiomas and discuss their pathogenesis, clinical characteristics, radiological findings, differential diagnosis, surgical interventions, pathological characteristics, and prognosis. Methods We retrospectively retrieved and analyzed the data of patients with pure epidural cavernous hemangiomas, who underwent spinal magnetic resonance imaging, and surgical intervention at the First Hospital of Jilin University, China, between January 2005 and December 2019. The data on patients’ clinical manifestations, imaging characteristics, surgical intervention, histopathological findings, and postoperative follow-up were also recorded and analyzed. Results In all, 5 men and 4 women with the mean age of 61 years (range, 41–78 years) were recruited. All patients experienced a gradual onset of symptoms and a slowly progressive clinical course, and no patient presented an acute onset of symptoms. The clinical manifestations include myelopathic signs in 8 patients (88.9%) and radicular symptoms in 3 patients (33.3%). On T1-weighted imaging, 6 lesions appeared isointense (55.6%), and 4 lesions exhibited hypointense (44.4%) signals. On T2-weighted imaging, 8 lesions appeared hyperintense (88.9%), and 1 lesion was heterogeneously intense (11.1%). Following gadolinium administration, 5 lesions appeared homogeneous with significant enhancement (55.6%), 1 lesion was homogeneous and mild enhancement (11.1%), and 3 lesions were heterogeneous with mild enhancement (33.3%). All patients received early microsurgery assisted by intraoperative electrophysiologic monitoring and neuronavigation in the lateral position via the posterior midline approach. Five patients underwent total laminectomy (55.6%), and 4 underwent hemilaminectomy (44.4%). Total excision was achieved in all cases. The average follow-up period was 55.1 months (ranging 10–123 months). All patients exhibited significant clinical improvement of their neurological deficits and achieved a favorable outcome with no recorded recurrence at last follow-up. Conclusions Spinal epidural cavernous hemangiomas are rare vascular malformations. Early surgical treatment with total resection is an optimum treatment, particularly for patients with an acute exacerbation onset. The prognosis is mostly good and depends predominantly on the severity of the preoperative status.
Collapse
Affiliation(s)
- Liyan Zhao
- Department of Clinical Laboratory, Second Hospital of Jilin University, Changchun, China
| | - Yining Jiang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yubo Wang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yang Bai
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Ying Sun
- Department of Clinical Laboratory, Second Hospital of Jilin University, Changchun, China
| | - Yunqian Li
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| |
Collapse
|
4
|
Santagada DA, Perna A, Meluzio MC, Ciolli G, Proietti L, Tamburrelli FC. Symptomatic vertebral hemangioma during pregnancy period: A case series and systematic literature review. Orthop Rev (Pavia) 2020; 12:8685. [PMID: 32913613 PMCID: PMC7459382 DOI: 10.4081/or.2020.8685] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022] Open
Abstract
Vertebral Hemangioma (VH) is a benign tumor usually symptomless and discovered incidentally. Pregnancy, because of several hormonal and physiologic changes, is a recognized risk factor coinciding with the development of a rapid onset of neurological symptoms in patients affected by VH. In the Literature, sporadic cases of neurological symptoms have been described, which occurred during pregnancy, but only rarely the onset of symptoms was reported after pregnancy and childbirth. Usually surgical treatment is reserved for severe cases with rapid onset of neurological symptoms. However, the use of conservative treatments is still a topic of debate In the present study, we report a series of patients affected by VH become symptomatic during or after pregnancy along with a systematic review of the Literature.
Collapse
Affiliation(s)
- Domenico Alessandro Santagada
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Maria Concetta Meluzio
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Gianluca Ciolli
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Luca Proietti
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| |
Collapse
|
5
|
Wang GX, Mu YD, Che JY, Zhang GF, Jiang G, Gao CP. Compressive myelopathy and compression fracture of aggressive vertebral hemangioma after parturition: A case report and review of literature. Medicine (Baltimore) 2019; 98:e18285. [PMID: 31852104 PMCID: PMC6922397 DOI: 10.1097/md.0000000000018285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Compressive myelopathy and compression fracture of aggressive vertebral hemangioma after parturition is a rare condition. Vertebral body compression fracture and high serum progesterone lead to extraosseous hemangioma enlargment cause narrowing the spinal canal which contribute to compressive myelopathy relate to pregnancy. PATIENT CONCERNS We report a case of compressive myelopathy and compression fracture of aggressive vertebral hemangioma after parturition in a 35-year-old woman. The patient complained unable to walk and experienced intense pain in the back. DIAGNOSIS Based on the clinical features and imaging studies, the patient underwent a T4-T6 laminectomy. Histopathology consistent with vertebral hemangioma. INTERVENTIONS The patient underwent laminectomy for decompression. After subperiosteal dissection of the paraspinal muscles and exposure of the laminae, there was no involvement of the lamina by the tumor. The epidural tumor was removed through the spaces lateral to the thecal sac. Vertebroplasty was performed through T5 pedicles bilaterally and 7 ml of polymethylmethacrylate (PMMA) cement was injected. T4-T6 pedicle screw fixation was performed for segmental fixation and fusion. OUTCOMES Six months after resection of the tumor the patient remained asymptomatic. She reported no low back pain and had returned to her normal daily activities, with no radiographic evidence of recurrence on MRI. Physical examination revealed that superficial and deep sensation was restored to normal levels in the lower extremities. LESSONS The occurrence of compressive myelopathy of pregnancy related vertebral hemangiomas is quite unusual. It can lead to serious neurologic deficits if not treated immediately. So, prompt diagnosis is important in planning optimal therapy and preventing morbidity for patients.
Collapse
Affiliation(s)
- Guan-xi Wang
- Department of Radiology, Songshan Hospital of Qingdao University Medical College University
| | - Yuan-dong Mu
- Department of Radiology, Gaomi people Hospital, Weifang
| | - Jun-yi Che
- Department of Radiology, Qingdao Municipal Hospital
| | | | | | - Chuan-ping Gao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| |
Collapse
|
6
|
Huang Y, Xu W, Chen Q, Lan Z. Treatment of Typical Enneking Stage 3 Thoracic Aggressive Vertebral Hemangiomas with Pain and Neurologic Deficits: Results After at Least 36 Months of Follow-Up. World Neurosurg 2019; 134:e642-e648. [PMID: 31689570 DOI: 10.1016/j.wneu.2019.10.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the efficiency of a comprehensive treatment strategy for patients with Enneking stage 3 thoracic aggressive vertebral hemangioma (AVH). METHODS A retrospective analysis of radiographic and clinical outcomes was performed for 17 patients who received treatment for Enneking stage 3 thoracic AVH accompanied by pain and neurologic deficits between January 2010 and February 2015. A visual analog scale (VAS) was used to clinically evaluate the level of pain. Neurologic examinations were performed to assess the patients' sensory symptoms, motor deficits, and Frankel grade. RESULTS The average operative time was 181.8 ± 37.1 minutes, and the average intraoperative blood loss was 1226.5 ± 151.2 mL (range, 900-1450 mL). All patients underwent preoperative embolization to minimize intraoperative blood loss. All patients experienced immediate pain relief and resolution of their neurologic symptoms. All 17 patients achieved Frankel grade D at the final follow-up; moreover, they reported that their pain was relieved (mean VAS score, 2.82 ± 0.81; P < 0.05) and their neurologic deficits had resolved. No surgery-related complications were noted. No patients exhibited signs of recurrence. CONCLUSIONS We recommend a comprehensive treatment strategy for patients with Enneking stage 3 thoracic AVH that includes preoperative embolization, vertebroplasty, posterior decompression, and internal fixation. We recommend that absorbable gelatin sponge particles be used for intraoperative embolization prior to the injection of bone cement, which may significantly reduce intraoperative bleeding, operative time, and occurrence of surgery-related complications.
Collapse
Affiliation(s)
- Yuming Huang
- Orthopedics Department, Fuzhou Second Hospital affiliated to Xiamen University, Fuzhou, China
| | - Weihong Xu
- Department of Spine Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qing Chen
- Department of Spine Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhibin Lan
- Spinal Surgery Department, Quanzhou Orthopedic-Traumatological Hospital of Fujian Traditional Chinese Medicine University, Quanzhou, China.
| |
Collapse
|
7
|
Bennis A, Hafiane R, Benouhoud J, El Khaoudi A, Ibahioin K, Lakhdar A, Moussaid I, El Youssoufi S, Salmi S. Epidural cavernous haemangioma during pregnancy: a case report and a literature review. Pan Afr Med J 2019; 33:202. [PMID: 31692775 PMCID: PMC6814345 DOI: 10.11604/pamj.2019.33.202.8481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 06/08/2016] [Indexed: 11/17/2022] Open
Abstract
Cavernous haemangiomas are benign vascular malformations that can locate in the central nervous system. The epidural spinal location remains unusual. Pregnancy is known to be a precipitating factor. The aim of this study is to review general aspects of these lesions and specific facts about their relationship to pregnancy. A 32-year-old full-term pregnant woman is managed during early labor for a progressive spinal cord compression syndrome. After delivery, exploration by a lumbar MRI found an epidural vascular dorsal mass. Surgical exploration and histopathological examination confirmed the diagnosis of epidural cavernous haemangioma. The patient achieved complete recovery after 1 month. Spinal cavernous haemangiomas are rare malformations. Specific mechanisms seems to be involved in their growth during pregnancy. Although clinical and radiological presentation are spectacular and misleading, the prognosis is generally good, and urgent surgical treatment during pregnancy is usually not indicated.
Collapse
Affiliation(s)
- Anas Bennis
- Anaesthesiology unit, Department of Obstetrics and Gynaecology, Ibn Rochd University Hospital, Casablanca, Morocco.,Department of Neurology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Reda Hafiane
- Anaesthesiology unit, Department of Obstetrics and Gynaecology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Jaafar Benouhoud
- Anaesthesiology unit, Department of Obstetrics and Gynaecology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Amine El Khaoudi
- Anaesthesiology unit, Department of Obstetrics and Gynaecology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Khadija Ibahioin
- Department of Neurosurgery, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Abdelhakim Lakhdar
- Department of Neurosurgery, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Ihsane Moussaid
- Anaesthesiology unit, Department of Obstetrics and Gynaecology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Smaïl El Youssoufi
- Anaesthesiology unit, Department of Obstetrics and Gynaecology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Said Salmi
- Anaesthesiology unit, Department of Obstetrics and Gynaecology, Ibn Rochd University Hospital, Casablanca, Morocco
| |
Collapse
|
8
|
Vertebral Hemangioma. Neuroradiology 2019. [DOI: 10.1016/b978-0-323-44549-8.00029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
9
|
Wang B, Jiang L, Wei F, Liu XG, Liu ZJ. Progression of aggressive vertebral hemangiomas during pregnancy: Three case reports and literature review. Medicine (Baltimore) 2018; 97:e12724. [PMID: 30290682 PMCID: PMC6200486 DOI: 10.1097/md.0000000000012724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Vertebral hemangiomas (VHs), one of the most common benign tumors of the spine, can be aggressive, which is a rare condition and causes neurological deficits. Pregnancy is related to the worsening of aggressive VHs. The diagnosis and treatment of aggressive VHs remain challenging, especially for pregnant cases. PATIENT CONCERNS We report 3 cases of aggressive VH in women who developed progressive neurological deficits during pregnancy among 95 patients treated for aggressive VH in our hospital in the past 15 years. DIAGNOSES AND INTERVENTIONS All 3 patients experienced progressive deterioration of neurological function and pain at 13, 28, and 41 weeks' gestation. On radiological examination, VHs were the suspected radiological diagnoses in 2 patients; 1 patient was preoperatively misdiagnosed with a spinal metastatic tumor. All 3 patients underwent decompression surgery with intraoperative vertebroplasty and/or postoperative radiotherapy. The pathological diagnosis after surgery was all hemangiomas. OUTCOMES In all 3 patients, there were no tumor recurrences, and neurological functions remained normal at the last follow-up of 75, 38, and 15 months after the treatment, respectively. LESSONS Pregnancy might lead to the onset of aggressive VHs. The diagnosis and treatment of VHs during pregnancy remain controversial due to concern for both maternal and fetal safety. Timely surgery could preserve neurological function. Decompression surgery by laminectomy followed by adjuvant therapies require less skill and have a shorter surgery time, and can be considered more appropriate for aggressive VHs with pregnancy.
Collapse
Affiliation(s)
- Ben Wang
- Department of Orthopaedic, Peking University Third Hospital
- Peking University Health and Science Center, Beijing, China
| | - Liang Jiang
- Department of Orthopaedic, Peking University Third Hospital
| | - Feng Wei
- Department of Orthopaedic, Peking University Third Hospital
| | - Xiao Guang Liu
- Department of Orthopaedic, Peking University Third Hospital
| | - Zhong Jun Liu
- Department of Orthopaedic, Peking University Third Hospital
| |
Collapse
|
10
|
Fereydonyan N, Taheri M, Kazemi F. Recurrent symptomatic vertebral hemangioma during two consecutive pregnancies: Case report and review of the literature. Surg Neurol Int 2017; 8:105. [PMID: 28695052 PMCID: PMC5473073 DOI: 10.4103/sni.sni_93_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/09/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Pregnancy-related changes can exacerbate the symptoms/signs of vertebral hemangiomas. Here, we report a patient who experienced symptomatic vertebral hemangiomas resulting in cord compression during two consecutive pregnancies. CASE DESCRIPTION A 28-year-old female 34 weeks pregnant, presented with a progressive spastic paraparesis. Magnetic Resonance Imaging (MRI) demonstrated an T5 vertebral body signal change attributed to a hemangioma resulting in cord compression. Following a cesarean section, she had a trans thoracic T5 corpectomy with spinal fusion. Indeed, the histopathology was consistent with a vertebral hemangioma. She fully recovered after this first surgery. However, six years later, she again presented with a spastic paraparesis and sphincter deficit now 29 weeks pregnant. The MR demonstrated cord compression one more at the T5 level attributed to the hemangioma; following a T5 and T6 laminectomy, the left paracentral epidural vascular mass totally resected. Her child was successfully delivered 2 months later at which point she exhibited only mild residual lower limb spasticity. CONCLUSION Patients with known vertebral hemangiomas should be closely monitored during pregnancy as increased growth during these pregnancies may result in progressive spinal cord compression.
Collapse
Affiliation(s)
| | - Morteza Taheri
- Department of Neurosurgery, Rasool Akram Hospital, Tehran, Iran
| | - Farid Kazemi
- Department of Neurosurgery, Rasool Akram Hospital, Tehran, Iran
| |
Collapse
|
11
|
Abstract
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.
Collapse
Affiliation(s)
| | - John H Chi
- Brigham and Women's Hospital, Harvard Medical School; and.,Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Michael W Groff
- Brigham and Women's Hospital, Harvard Medical School; and.,Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| |
Collapse
|
12
|
Abstract
STUDY DESIGN This cross-sectional study was carried out on 196 adults (98 men and 98 women), aged between 18 and 91 years. OBJECTIVE To examine whether vertebral hemangiomas (VHs) are associated with other spinal pathologies, metabolic diseases, cardiovascular diseases, cancer and past trauma, to shed light on their possible pathophysiology. SUMMARY OF BACKGROUND DATA VHs are the most common form of benign tumors in the spine. Their association with spinal and systemic pathologies has not yet been systematically studied. METHODS Clinical data were gathered from full spine CT scans and medical records. RESULTS VHs were significantly associated with disc lesions (P = 0.004), past trauma (P = 0.037), diabetes (χ = 5.179, P = 0.023), cardio-vascular diseases (χ = 8.625, P = 0.003), and cancer (χ = 5.820, P = 0.016), but not with obesity. Only medium-large size VHs were significantly associated with osteoporosis (χ = 6.695, P = 0.010). CONCLUSION The pattern of diseases related to VHs suggests a common cause for VH, namely, a disruption of vascular flow in the microvessels (accompanied by endothelium damage) within the vertebral body, eventually resulting in hypervascularization. LEVEL OF EVIDENCE 4.
Collapse
|
13
|
Slon V, Stein D, Cohen H, Sella-Tunis T, May H, Hershkovitz I. Vertebral hemangiomas: their demographical characteristics, location along the spine and position within the vertebral body. 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 2015; 24:2189-95. [PMID: 25987455 DOI: 10.1007/s00586-015-4022-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 05/12/2015] [Accepted: 05/13/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Vertebral hemangiomas (VHs) are the most common form of benign tumors in the spine. The aim of this research was to study the prevalence of VHs in the human population, their distribution along the spine and their location in the vertebral body. METHODS The presence of VHs was assessed in full spine CT scans of 196 adults. Demographic data were gathered from medical records. RESULTS VHs were present in 26.0% of the individuals studied, a rate significantly higher (χ2=43.338, p<0.001) than the prevalence reported in the literature (10.7%). Multiple VHs (≥2) appeared in 7.2% of the population studied. VHs prevalence is sex-independent, appearing in 28.6% of females and 23.5% of males (χ2=0.663, p=0.416); and age-dependent: the mean age of affected individuals (65.8 years) was significantly higher (p<0.001) than unaffected individuals (56.2 years). VH size was also age-dependent (p=0.023). No vertebra was significantly more prone to be affected by a hemangioma. T11 and T12 show the highest prevalence of VHs (3.57% of vertebrae affected). VHs were found in similar percentages in the anterior and posterior parts of the vertebral body (52.8 vs. 47.2%, respectively); and at its center and periphery (50.1 and 49.9%, respectively). VHs usually appeared at mid-height of the vertebral body or slightly higher. CONCLUSIONS The reported prevalence of VHs is dependent on the demographic structure of the population studied, the size of the VHs and the method used to identify them. Overall, the phenomenon is more frequent than usually reported. VHs may appear at all vertebral levels and in all areas of the vertebral body.
Collapse
Affiliation(s)
- Viviane Slon
- Department of Anatomy and Anthropology, The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel
| | - Dan Stein
- Department of Anatomy and Anthropology, The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel
| | - Haim Cohen
- Department of Anatomy and Anthropology, The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel
| | - Tatiana Sella-Tunis
- Department of Anatomy and Anthropology, The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel.,The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel
| | - Hila May
- Department of Anatomy and Anthropology, The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel
| | - Israel Hershkovitz
- Department of Anatomy and Anthropology, The Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel.
| |
Collapse
|
14
|
Slimani O, Jayi S, Fdili Alaoui F, Bouguern H, Chaara H, Fikri G, Alaoui Rachidi S, Sqalli Houssaini N, Himmich M, Abdelilah Melhouf M. An aggressive vertebral hemangioma in pregnancy: a case report. J Med Case Rep 2014; 8:207. [PMID: 24943121 PMCID: PMC4088364 DOI: 10.1186/1752-1947-8-207] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/21/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction Pregnancy-related compressive myelopathy secondary to vertebral hemangioma is a rare occurrence and its treatment antepartum is rare. Case presentation A 19-year-old North African woman in her 38th week of pregnancy presented with paraplegia that progressed within 2 days after a rapidly progressive weakness of her lower limbs. Magnetic resonance imaging studies showed compression of her spinal cord in front of the fourth thoracic vertebra for suspected tuberculous spondylitis. A Caesarean section was done followed by corpectomy with a bone graft because we intraoperatively discovered a vertebral hemangioma. Pathology showed an aggressive hemangioma. Conclusion At any term of pregnancy, extensive neurological involvement which is rapidly progressive due to compression should be considered for immediate decompression.
Collapse
Affiliation(s)
- Ouafae Slimani
- Department of Gynecology Obstetric II, Teaching Hospital Hassan II, Fez, Morocco.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Gupta M, Nayak R, Singh H, Khwaja G, Chowdhury D. Pregnancy related symptomatic vertebral hemangioma. Ann Indian Acad Neurol 2014; 17:120-2. [PMID: 24753678 PMCID: PMC3992751 DOI: 10.4103/0972-2327.128577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/05/2013] [Accepted: 06/06/2013] [Indexed: 11/15/2022] Open
Abstract
Vertebral hemangiomas are benign vascular tumors of the spine that remain asymptomatic in most cases and incidentally encountered on imaging. Rarely, altered hemodynamic and hormonal changes during pregnancy may expand these benign lesions resulting in severe cord compression. The management of symptomatic vertebral hemangioma during pregnancy is controversial as modalities like radiotherapy and embolization are not suitable and surgery during pregnancy has a risk of preterm labor. Few cases of pregnancy related symptomatic vertebral hemangioma with marked epidural component have been reported in the literature. We report a case of 23-year-old primigravida who developed rapidly progressive paraparesis at 28 weeks of gestation and spine magnetic resonance imaging (MRI) revealed upper thoracic vertebral hemangioma with extensive extra-osseous extension and spinal cord compression. Laminectomy and surgical decompression of the cord was performed at 32 weeks of the pregnancy. There was significant improvement in muscle power after a week of surgery. Six weeks postoperatively she delivered a full term normal baby with subsequent improvement of neurologic deficit. Repeat MRI of dorsal spine performed at 3 months postoperatively showed reduced posterior and anterior epidural components of vertebral hemangioma.
Collapse
Affiliation(s)
- Meena Gupta
- Department of Neurology, GB Pant Hospital, New Delhi, India
| | - Rajeev Nayak
- Department of Neurology, GB Pant Hospital, New Delhi, India
| | - Hukum Singh
- Department of Neurosurgery, GB Pant Hospital, New Delhi, India
| | - Geeta Khwaja
- Department of Neurology, GB Pant Hospital, New Delhi, India
| | | |
Collapse
|
16
|
Moles A, Hamel O, Perret C, Bord E, Robert R, Buffenoir K. Symptomatic vertebral hemangiomas during pregnancy. J Neurosurg Spine 2014; 20:585-91. [PMID: 24605997 DOI: 10.3171/2014.2.spine13593] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Symptomatic vertebral hemangiomas during pregnancy are rare, as only 27 cases have been reported in the literature since 1948. However, symptomatic vertebral hemangiomas can be responsible for spinal cord compression, in which case they constitute a medical emergency, which raises management difficulties in the context of pregnancy. Pregnancy is a known factor responsible for deterioration of these vascular tumors. In this paper, the authors report 2 clinical cases of symptomatic vertebral hemangiomas during pregnancy, including 1 case of spontaneous fracture that has never been previously reported in the literature. The authors then present a brief review of the literature to discuss emergency management of this condition. The first case was a 28-year-old woman at 35 weeks of gestation, who presented with paraparesis. Spinal cord MRI demonstrated a vertebral hemangioma invading the body and posterior arch of T-3 with posterior epidural extension. Laminectomy and vertebroplasty were performed after cesarean section, allowing neurological recovery. The second case involved a 35-year-old woman who presented with spontaneous fracture of T-7 at 36 weeks of gestation, revealing a vertebral hemangioma with no neurological deficit, but it was responsible for pain and local instability. Treatment consisted of postpartum posterior interbody fusion. With a clinical and radiological follow-up of 2 years, no complications and no modification of the hemangiomas were observed. A review of the literature reveals discordant management of these rare cases, which is why the treatment course must be decided by a multidisciplinary team as a function of fetal gestational age and maternal neurological features.
Collapse
Affiliation(s)
- Alexis Moles
- Department of Neurosurgery and Neurotraumatology
| | | | | | | | | | | |
Collapse
|
17
|
Lousquy R, Morel O, Bisdorff A, Drouet L, Rossignol M, Barranger E. [Pregnancy follow-up and outcome in women with superficial vascular malformations]. ACTA ACUST UNITED AC 2010; 38:350-7. [PMID: 20430676 DOI: 10.1016/j.gyobfe.2009.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 10/31/2009] [Indexed: 11/29/2022]
Abstract
Superficial vascular malformations (MAV), so far called "superficial angioma", are uncommon and often unknown. The last classification, done by the "International Society for the Study of Vascular Anomalies", is essential to avoid diagnostic and therapeutic mistakes. Extramedullar localisations are rare. The coexistence of a pregnancy and a MAV states two problems: the medical and paraclinic supervision of the volume of the MAV and its risk of thrombosis with the choice of thrombosis prevention, and the mode of delivery and type of anaesthesia depending on its anatomical location. We revised the management of pregnant women with a MAV illustrating possible troubles to deal with. We reported the cases of two women having for the first one a pharyngolaryngeal MAV, the second a cutaneous MAV located on the leg and needing a multidisciplinary management with obstetricians, anaesthesists, hematologists, dermatologists, ENT, radiologists and pediatricians.
Collapse
Affiliation(s)
- R Lousquy
- Service de gynécologie obstétrique, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | | | | | | | | | | |
Collapse
|
18
|
Hayden MG, Gephart R, Kalanithi P, Chou D. Von Hippel-Lindau disease in pregnancy: A brief review. J Clin Neurosci 2009; 16:611-3. [DOI: 10.1016/j.jocn.2008.05.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 05/19/2008] [Accepted: 05/22/2008] [Indexed: 11/29/2022]
|
19
|
Kiroglu Y, Benek B, Yagci B, Cirak B, Tahta K. Spinal cord compression caused by vertebral hemangioma being symptomatic during pregnancy. ACTA ACUST UNITED AC 2008; 71:487-92; discussion 492. [PMID: 18295858 DOI: 10.1016/j.surneu.2007.09.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Accepted: 09/06/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hemangioma is one of the most common benign tumors of the spine, and it remains silent in the vast majority of subjects afflicted. Pregnancy is a known risk factor for symptomatic conversion of the previously silent vertebral hemangiomas. However, the occurrence is rare with only 26 cases reported in the English medical literature. CASE DESCRIPTION A 22-year-old woman in her 36th week of gestation presented with acute onset of upper back pain and progressive paraplegia. Imaging studies revealed a T4 vertebral hemangioma, which involved the vertebral body, pedincules, transverse, and spinous process with a focal extradural extension of soft tissue component. She underwent emergent cesarean delivery and endovascular embolization, respectively. Her symptoms and neurologic deficits improved quickly. Her complaints restarted 2 years after embolization. Surgical treatment which consists of intraoperative vertebraplasty and segmental fixation was performed. The patient's postoperative recovery was excellent. CONCLUSION According to literature review and our patient's outcome, pregnancy may induce neurologic symptoms and signs in silent spinal hemangiomas. The way of management is decided by whether the neurologic deficits depend on the deformity caused by hemangioma or some other factors including vascular insufficiency.
Collapse
Affiliation(s)
- Yilmaz Kiroglu
- Department of Radiology, Pamukkale University Medical School, Denizli, Turkey
| | | | | | | | | |
Collapse
|
20
|
Vijay K, Shetty AP, Rajasekaran S. Symptomatic vertebral hemangioma in pregnancy treated antepartum. A case report with review of literature. 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 2008; 17 Suppl 2:S299-303. [PMID: 18224354 DOI: 10.1007/s00586-008-0592-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Revised: 11/07/2007] [Accepted: 12/22/2007] [Indexed: 11/30/2022]
Abstract
Pregnancy related compressive myelopathy secondary to vertebral hemangioma is a rare occurrence and its treatment antepartum is rare. We report a 22-year-old lady in her 26th-week of pregnancy who was treated in two stages--antepartum with a laminectomy and posterior stabilization. This resulted in complete recovery of the neurological deficits. She delivered a normal baby after 3 months, following which a corpectomy and fusion was performed. This two-staged approach appears safe and effective in treating symptomatic vertebral haemangiomas causing neurological deficits during pregnancy. A review of relevant literature has been done.
Collapse
Affiliation(s)
- Kamath Vijay
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu, 641 011, India
| | | | | |
Collapse
|
21
|
Heyd R, Seegenschmiedt MH. Vertebral Hemangioma (VH). RADIOTHERAPY FOR NON-MALIGNANT DISORDERS 2008. [DOI: 10.1007/978-3-540-68943-0_23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
|
22
|
Safavi-Abbasi S, Feiz-Erfan I, Spetzler RF, Kim L, Dogan S, Porter RW, Sonntag VKH. Hemorrhage of cavernous malformations during pregnancy and in the peripartum period: causal or coincidence? Case report and review of the literature. Neurosurg Focus 2006; 21:e12. [PMID: 16859250 DOI: 10.3171/foc.2006.21.1.13] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is growing evidence to suggest that pregnancy may increase the risk of hemorrhage from cavernous malformations (CMs). In the present case, a 21-year-old primigravida was admitted to the authors' neurosurgical service after a cesarean section. Three weeks before admission she had experienced rapidly progressive bilateral lower-extremity paresthesias. Spinal magnetic resonance (MR) imaging revealed the presence of an intramedullary thoracic lesion. On T2-weighted MR images, heterogeneous signal intensity with a rim of decreased intensity was demonstrated in the spine. The mass was successfully resected, and 1 year later the patient's symptoms had resolved completely. This is the fourth reported case of a spinal intramedullary CM that became symptomatic during pregnancy. The pathogenesis and management of this entity are reviewed.
Collapse
Affiliation(s)
- Sam Safavi-Abbasi
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
| | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
Pregnancy is a recognized risk factor for quiescent vertebral hemangiomas becoming symptomatic; this usually occurs during the 3rd month of gestation. The natural history of these lesions is poorly understood, and treatment practices must consider the overall safety of the mother and fetus. The authors report a case of cervical vertebral hemangioma presenting during the 24th week of pregnancy and review the current literature.
A 26-year-old woman in her 24th week of pregnancy presented with upper-back pain and progressive spastic paresis in the legs. Neuroimaging studies revealed a diffuse C-7 vertebral body lesion with extradural extension and compression of the spinal cord consistent with a vertebral hemangioma. Successful decompression was accomplished, and the fetus experienced no adverse effects from the surgery.
In a review of the literature, 23 cases of pregnancy-related vertebral hemangioma dating back to 1927 were identified. Prepartum surgical decompression was performed in eight patients, postpartum surgery was performed in 12, and surgery was not performed in four. Overall, patients experienced excellent neurological recovery, regardless of the severity and duration of spastic paresis.
Observation should be considered for symptomatic patients at greater than 32 weeks gestation. Surgery should be considered for patients with severe neurological deficits at less than 32 weeks of gestation.
Collapse
Affiliation(s)
- John H Chi
- Department of Neurological Surgery, San Francisco General Hospital, University of California, San Francisco, California, USA.
| | | | | |
Collapse
|
24
|
Estrogen and Progesterone Receptor-negative T11 Vertebral Hemangioma Presenting as a Postpartum Compression Fracture: Case Report and Management. Neurosurgery 2000. [DOI: 10.1097/00006123-200001000-00045] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
25
|
Schwartz TH, Hibshoosh H, Riedel CJ. Estrogen and Progesterone Receptor-negative T11 Vertebral Hemangioma Presenting as a Postpartum Compression Fracture: Case Report and Management. Neurosurgery 2000. [DOI: 10.1093/neurosurgery/46.1.218] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Theodore H. Schwartz
- Department of Neurological Surgery The Neurological Institute of New York, New York Presbyterian Medical Center
| | - Hanina Hibshoosh
- Department of Pathology College of Physicians and Surgeons, Columbia University, New York, New York
| | - Charles J. Riedel
- Department of Neurological Surgery The Neurological Institute of New York, New York Presbyterian Medical Center
| |
Collapse
|
26
|
Pastushyn AI, Slin'ko EI, Mirzoyeva GM. Vertebral hemangiomas: diagnosis, management, natural history and clinicopathological correlates in 86 patients. SURGICAL NEUROLOGY 1998; 50:535-47. [PMID: 9870814 DOI: 10.1016/s0090-3019(98)00007-x] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Vertebral hemangiomas are characterized by diverse clinical histories, radiological features, and results of surgical treatment. It still remains unclear how these differences in clinical behavior relate to pathological type. METHODS A retrospective diagnostic, surgical, and histopathological study of 86 consecutive patients with various pathological types of vertebral hemangioma was performed to establish clinicopathological correlates. RESULTS The study confirmed that differences exist in clinical course, appearance on imaging, and outcomes in pathological types of hemangiomas. Based on these findings the authors attempted to identify signs characterizing each group. CONCLUSIONS Differences in clinical history and radiological features exist among pathological types of vertebral hemangiomas. These differences cannot precisely predict the type pathology before histologic examination, but do help us to understand the natural history of such lesions more fully.
Collapse
Affiliation(s)
- A I Pastushyn
- Department of Spinal Neurosurgery, Romodanov Institute of Neurosurgery, Kiev, Ukraine
| | | | | |
Collapse
|
27
|
Mills GH, Howell SJ, Richmond MN. Spinal cord compression immediately following, but unrelated to, epidural analgesia. Anaesthesia 1994; 49:954-6. [PMID: 7802239 DOI: 10.1111/j.1365-2044.1994.tb04311.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A patient developed spinal cord compression following epidural analgesia. The diagnosis was made difficult by the presence of epidural analgesia, although the compression was not in fact related to the analgesic technique employed. This case highlights the need for close observation of patients in whom epidural analgesia is, or has recently been, employed and the need to consider alternative reasons for neurological deficit.
Collapse
Affiliation(s)
- G H Mills
- Jessop Hospital for Women, Sheffield
| | | | | |
Collapse
|
28
|
Vertebral Hemangioma Symptomatic during Pregnancy???Report of a Case and Review of the Literature. Neurosurgery 1993. [DOI: 10.1097/00006123-199302000-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
29
|
Tekkök IH, Açìkgöz B, Sağlam S, Onol B. Vertebral hemangioma symptomatic during pregnancy--report of a case and review of the literature. Neurosurgery 1993; 32:302-6; discussion 306. [PMID: 8437670 DOI: 10.1227/00006123-199302000-00022] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A spinal tumor complicating pregnancy is a rare condition. A 25-year-old woman who became paraplegic during the 35th week of her second pregnancy presented during the postpartum period. She underwent two surgical interventions, and the cord compression caused by a T5 vertebral body hemangioma with laminar involvement and extradural extension was relieved. The occurrence of vertebral hemangiomas during pregnancy is discussed; the radiological features with special reference to magnetic resonance imaging are outlined; and cases from the literature are reviewed.
Collapse
Affiliation(s)
- I H Tekkök
- Department of Neurosurgery, Hacettepe University School of Medicine, Ankara, Turkey
| | | | | | | |
Collapse
|
30
|
Fox MW, Onofrio BM. The natural history and management of symptomatic and asymptomatic vertebral hemangiomas. J Neurosurg 1993; 78:36-45. [PMID: 8416240 DOI: 10.3171/jns.1993.78.1.0036] [Citation(s) in RCA: 208] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Fifty-nine cases of vertebral hemangioma were seen at the Mayo Clinic between 1980 and 1990. Vertebral hemangiomas were discovered incidentally in 35 patients, while pain was the presenting complaint in 13 patients. Five patients presented directly with progressive neurological deficit requiring surgery, and six patients had surgery elsewhere for spinal cord compression and were referred for follow-up evaluation. To better define the natural history of these lesions, a historical review of these patients was conducted; progression of an asymptomatic or painful lesion to neurological symptoms was found in only two cases (mean follow-up period 7.4 years, range 1 to 35 years). New-onset back pain followed by subacute progression (mean time to progression 4.4 months, range 0.25 to 12 months) of a thoracic myelopathy was the most common presentation for patients with neurological deficit. Initially, all 11 patients with spinal cord compression underwent decompressive surgery with full neurological recovery. Recurrent neurological symptoms were observed in three of six patients following subtotal tumor resection and postoperative administration of 1000 cGy or less radiation therapy (mean follow-up period 8.7 years, range 1 to 17 years). No recurrences were noted in four patients who had subtotal excision plus radiotherapy between 2600 and 4500 cGy. One other patient had gross total tumor removal without radiotherapy and has not had a recurrence. Based on these patients and a review of the literature, the authors recommend annual neurological and radiological examinations for patients with hemangiomas associated with pain, especially young females with thoracic lesions in whom spinal cord compression is most likely to develop. Radiation therapy or embolization is an effective therapeutic alternative for patients with severe medically refractory pain. Regular follow-up monitoring for patients with asymptomatic lesions is unnecessary unless pain develops at the appropriate spinal level. It is concluded that management of patients with a progressive neurological deficit should include preoperative angiography and embolization, decompressive surgery with the approach determined by the degree of vertebral involvement and site of spinal cord compression, and postoperative radiation therapy in patients following subtotal tumor removal. Operative management and complications are discussed.
Collapse
Affiliation(s)
- M W Fox
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
31
|
Roelvink NC, Kamphorst W, August H, van Alphen M, Rao BR. Literature statistics do not support a growth stimulating role for female sex steroid hormones in haemangiomas and meningiomas. J Neurooncol 1991; 11:243-53. [PMID: 1823344 DOI: 10.1007/bf00165533] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A literature review of pregnancy-related vertebral haemangiomas, pregnancy-related haemangiomas outside the nervous system and its coverings, and pregnancy-related meningiomas was performed. All three conditions tended to occur during the first pregnancy, the second or third trimester, to ameliorate postpartum, and to recur during a subsequent pregnancy. These results suggested a hormonal influence on the clinical expression of haemangiomas and meningiomas. To test whether a hormonal factor is also operative in the (not pregnancy related) symptomatic and asymptomatic counterparts of these conditions we also reviewed the literature concerning the symptomatic and asymptomatic haemangiomas and meningiomas for the following: frequency, sex and age distribution. No arguments were found to suggest that steroid hormones are strong factors in the development of asymptomatic and symptomatic lesions. The pregnancy-related counterparts have to be considered as subsets with their own behaviour.
Collapse
Affiliation(s)
- N C Roelvink
- Div. of Neurosurgery, Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The Netherlands
| | | | | | | | | |
Collapse
|