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Kesavapisharady K, Divakar G, George T, E R J, Venkat Hariharan E. Compressive vertebral hemangiomas with neurological deficits: diagnosis, surgical strategies and long term outcome. Br J Neurosurg 2024; 38:735-745. [PMID: 34435527 DOI: 10.1080/02688697.2021.1967878] [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] [Received: 03/22/2021] [Revised: 06/29/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Compressive vertebral hemangiomas with neurological deficits (CVHND) form a rare, unique subset of lesions comprising of differing clinico-imaging findings, pathologic behavior and treatment, when compared to the commoner and usually incidental intra-osseus vertebral hemangiomas (VH). Though various surgical strategies and a broad array of adjuncts have evolved and changed over the years, there is paucity of comprehensive data from sizeable series of such patients treated surgically with long term follow up. The purpose of this study is to device an optimum management strategy in CVHND based on our surgical experience. MATERIALS AND METHODS The data from electronic medical records of 26 consecutive patients operated in our department from 2009 to 2019 were retrospectively analyzed. RESULTS There were 11 males and 15 females with a mean age of 34.7 years. Neurological examination revealed paraparesis or paraplegia with myelopathy in all patients with Frankel score of B, C and D in 1 (3.9%), 11 (42.3%) and 14 (53.8%) patients respectively. Sixteen patients (61%) underwent laminectomy and gross total excision of extradural soft tissue component, 7 (27%) laminectomy with posterolateral fusion, three (12%) underwent additional anterior interbody support. The mean follow up was 72.4 months and at last follow-up 24 patients (92%) were Frankel E. Symptomatic recurrence was seen in two patients operated early in the series, they underwent re-surgery, gross total excision with posterolateral fusion, remaining neurologically intact at last follow up. CONCLUSIONS Pre-operative embolization, surgical excision of extradural component and intra-operative vertebroplasty form the mainstay of treatment for CVHND. Instrumented posterolateral fusion with optional anterior interbody support accomplished through the same approach is required only in a minority of cases. The long-term outcome following timely and appropriate treatment is excellent. Anterior or anterolateral approaches for intervertebral support and radical procedures like total en-bloc spondylectomy (TES) are not usually required.
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Affiliation(s)
- Krishnakumar Kesavapisharady
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Ganesh Divakar
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Tobin George
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Jayadevan E R
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Easwer Venkat Hariharan
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
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Yucesoy K, Ertem O, Kilic T, Yilmaz M. Vertebral Hemangiomas: Yucesoy-Yilmaz Classification System with Corresponding Therapeutic Options. World Neurosurg 2024; 186:e151-e155. [PMID: 38522784 DOI: 10.1016/j.wneu.2024.03.096] [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] [Received: 01/09/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Vertebral hemangiomas (VHs) are relatively common, symptomatic benign tumors of the spine with a reported estimated incidence up to 11%. They usually appear in the body of the vertebrae; however, they can extend into pedicles, laminae, and epidural space. They may cause pain, neurologic deficits. and fractures. METHODS In this retrospective, single-center study, we reviewed our cases with VH and we propose the novel classification system that evaluates these lesions per their views on magnetic resonance imaging and clinical findings under 4 main categories. RESULTS Our novel classification system proposes that grade I lesions occupy less than 50% of the vertebral body, whereas grade II lesions occupy more than 50% and grade III lesions occupy the whole corpus. Grade IV lesions show an epidural and pedicular extension. We propose that grade I lesions may not be worthwhile for follow-up, whereas asymptomatic grade II (a) lesions to be worthy for a biannual imaging and symptomatic thoracolumbar grade II (b) and thoracolumbar grade III lesions to be considered for percutaneous vertebroplasty. We imply that decompression, posterior spinal instrumentation, and open vertebroplasty may be performed for thoracolumbar grade IV lesions. We further consider cervical grade IIb, III, and grade IV lesions as operable because of the disadvantages of percutaneous vertebroplasty. CONCLUSIONS We suggest that our novel classification system may be useful for the determination of diagnostic and therapeutic procedures in the management of VH. Further multicentric trials on larger series are warranted to validate this system and popularize its utility in larger populations.
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Affiliation(s)
- Kemal Yucesoy
- Department of Neurosurgery, Faculty of Medicine, Bahce Sehir University, Istanbul, Turkey
| | - Onder Ertem
- Department of Neurosurgery, Faculty of Medicine, Bahce Sehir University, Istanbul, Turkey.
| | - Turker Kilic
- Department of Neurosurgery, Faculty of Medicine, Bahce Sehir University, Istanbul, Turkey
| | - Murat Yilmaz
- Department of Neurosurgery, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Patel AA, Lilly D, Chao ST, Benzel E, Subramaniam G, Krishnaney A, Suh JH, Angelov L. Effective and Successful Control of Symptomatic Vertebral Hemangiomas With Epidural Extension Using Stereotactic Spine Radiosurgery. Neurosurgery 2024:00006123-990000000-01132. [PMID: 38713900 DOI: 10.1227/neu.0000000000002947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/16/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES We present our experience in the management of symptomatic vertebral hemangiomas with epidural extension (SVHEE) using spine stereotactic radiosurgery (SSRS). METHODS An Institutional Review Board approved retrospective review of all SVHEE patients treated with SSRS at our institution (2007-2022) was performed. Baseline patient demographics, clinical presentation, lesion volume, and Bilsky grade (to directly evaluate the epidural component) were determined. Clinical and radiographic response and treatment outcomes were subsequently evaluated at first (∼6 months) and final follow-up. RESULTS Fourteen patients with SVHEE underwent SSRS (16-18 Gy/1-fraction); the mean follow-up was 24 months. The median lesion volume (cc) was 36.9 (range: 7.02-94.1), 31.5 (range: 6.53-69.7), and 25.15 (range: 6.01-52.5) at pre-SSRS, first, and final follow-up, respectively. Overall volume reduction was seen in the last follow-up in all 14 patients, median 29.01% (range: 6.58%-71.58%). Bilsky score was stable or improved in all patients at the last follow-up when compared with pre-SSRS score. Patients who underwent both surgical decompression and SSRS (n = 9): 8 had improved myelopathic symptoms and pain and 1 had stable radiculopathy postintervention. In the 5 patients treated with SSRS monotherapy, 2 had stable radicular pain and the other 3 improved pain and numbness. No patients experienced adverse outcomes. CONCLUSION To our knowledge, this represents the largest series of SVHEE patients treated with SSRS, either as monotherapy or part of a multimodal/separation surgery treatment approach. We demonstrate that SSRS represents a potentially safe and effective treatment option in these patients. However, larger prospective studies and longer follow-ups are necessary to further assess the role, durability, and toxicity of SSRS in the management of these patients.
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Affiliation(s)
- Arpan A Patel
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Lilly
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samuel T Chao
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Edward Benzel
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gandhivarma Subramaniam
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ajit Krishnaney
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - John H Suh
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lilyana Angelov
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, USA
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Wu S, Zhong D, Zhao G, Wang L, Liu Y, Ke Z, Yan Z, Deng Z, Wang Y. Percutaneous Vertebroplasty for Cervical Symptomatic Hemangiomas and Spinal Metastases: A Case Series and Literature Review. World Neurosurg 2024; 184:e247-e254. [PMID: 38272304 DOI: 10.1016/j.wneu.2024.01.104] [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] [Received: 12/20/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Percutaneous vertebroplasty (PVP) is a commonly used technique for the treatment of spinal diseases, but it is rarely employed for cervical lesions. This study presents a case series and a literature review to evaluate the efficacy of cervical PVP. METHODS From August 2013 to January 2023, 14 patients underwent cervical PVP in the author's institution. The mean postoperative follow-up time was 20.3 ± 12.1 months (ranging from 5 to 41 months). The pain status and quality of life were assessed preoperatively, postoperatively, and during follow-up using the Visual Analog Scale and Neck Disability Index. Additionally, complications that occurred during the study period were documented. RESULTS The series of cases included 9 cases of hemangiomas and 5 cases of spinal metastases. The common symptom was axial pain in the neck. All patients were successfully treated with PVP. Visual analog scale scores decreased from 6.6 ± 0.8 preoperatively to 1.9 ± 0.8 at 24 hours postoperatively and to 2.4 ± 1.2 at the last follow-up (P < 0.01). Neck Disability Index decreased from 22.3% ± 8.9% preoperatively to 7.6% ± 8.1% at 24 hours postoperatively and to 6.0% ± 7.2% at 12-month follow-up (P < 0.01). After the operation, a case of dysphagia occurred, but no major complications were observed during the follow-up period. CONCLUSIONS Cervical PVP via the anterolateral approach is a safe option for the treatment of cervical symptomatic hemangiomas and spinal metastases with limited invasiveness. It is effective in relieving pain and improving quality of life.
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Affiliation(s)
- Shan Wu
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dian Zhong
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guosheng Zhao
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liyuan Wang
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Liu
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhenyong Ke
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengjian Yan
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhongliang Deng
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Wang
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Burgess L, Malone J, dos Santos MP, Sinclair J, Zalay O, Malone S. Clinical and radiographic response of a paravertebral hemangioma to radiotherapy. Radiol Case Rep 2024; 19:988-993. [PMID: 38155745 PMCID: PMC10751835 DOI: 10.1016/j.radcr.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/07/2023] [Accepted: 11/11/2023] [Indexed: 12/30/2023] Open
Abstract
Hemangiomas can arise anywhere in the body. While vertebral hemangiomas are common, atypical hemangiomas with paraspinal and epidural extension are rare. We present a case of a patient who presented with persistent cough and anorexia from a paravertebral hemangioma that invaded the adjacent vertebrae and neural foramen causing moderate spinal canal stenosis. She was treated with stereotactic body radiotherapy to prevent the development of symptomatic spinal cord compression. The hemangioma underwent significant shrinkage and her cough resolved. This case demonstrates impressive and sustained clinical and radiographic response of a paraspinal hemangioma to stereotactic body radiotherapy.
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Affiliation(s)
- Laura Burgess
- Department of Radiology, Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Radiology, Division of Radiation Oncology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Julia Malone
- Department of Radiology, Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Radiology, Division of Radiation Oncology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marlise P. dos Santos
- Department of Radiology, Radiation Oncology and Medical Physics, Section of Neuroradiology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Surgery Divisions of Neurosurgery and Interventional Neuroradiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - John Sinclair
- Department of Surgery, Division of Neurosurgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Osbert Zalay
- Department of Radiology, Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Radiology, Division of Radiation Oncology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shawn Malone
- Department of Radiology, Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Radiology, Division of Radiation Oncology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Diarra MD, Zhang Z, Wang Z, Yinwang E, Li H, Wang S, Lin P, Huang X, Ye Z. Surgical Options for Aggressive Vertebral Hemangiomas:A case series, literature review and treatment recommendations. J Bone Oncol 2023; 43:100515. [PMID: 38125609 PMCID: PMC10730854 DOI: 10.1016/j.jbo.2023.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose We retrospectively study twenty-nine surgical cases of aggressive vertebral hemangiomas (AVHs) with neurological deficits and extradural compression to determine the optimal surgical treatment strategy for AVHs at a single institution. Methods Patients with AVHs with neurological deficits who underwent partial tumor resection plus decompression with or without vertebroplasty (VP), and radiotherapy between 2010 and 2021 were included in this study. Clinical characteristics, surgical outcomes, and follow-up data of the patients were reviewed retrospectively. Results Twenty-nine AVH cases with neurological deficits and spinal instability were included in this study and treated surgically. The mean operation time of patients with decompression surgery plus VP (Groupe A) was 215.9 (120-265 min), shorter than that of decompression surgery without VP (Group B) 240.2 (120-320 min). Intraoperative blood loss was 273.3 (100-550 mL) in group A and 635.3 (200-1600 mL) in group B. In addition, a significant reduction in blood loss was observed in group A compared to the group B (p=0.0001). All patients experienced immediate pain relief and improvement in their neurological symptoms. Neurological function was assessed by the Frankel score, ASIA score, and the visual analogue scale (VAS) pain score decreased from 7.4 (4-9) to 1.3 (0-3). Of twenty-nine patients in this study, only 7% (2/29 patients) showed signs of recurrence. Conclusion Decompression plus VP achieve good tumor control and decrease surgical complication. Preoperative vascular embolization and VP can reduce intraoperative bleeding in the treatment of AVH surgery. Moreover, postoperative radiotherapy seems to be a good technique to prevent tumor recurrence.
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Affiliation(s)
- Mohamed Diaty Diarra
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Zengjie Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Zhan Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Eloy Yinwang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Hengyuan Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Shengdong Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Peng Lin
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Xin Huang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
| | - Zhaoming Ye
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou 310000, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310000, China
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Sharma S, Kamal R, Rathi AK. Vertebral hemangioma - the current radiation therapy perspective. Rep Pract Oncol Radiother 2023; 28:93-101. [PMID: 37122908 PMCID: PMC10132198 DOI: 10.5603/rpor.a2023.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/06/2023] [Indexed: 05/02/2023] Open
Abstract
Vertebral hemangiomas are benign tumors of the spine, most often detected incidentally and on other instances, when signs and symptoms of the disease arise. About 10% of the population are affected worldwide with a female to male ratio of 2:1. The majority of these cases are asymptomatic and no intervention is generally required. Less often, back pain and neurological deficit may occur. Such hemangiomas are termed aggressive by the Enneking staging and warrant treatment. In this review, staging and diagnostics are discussed in detail followed by treatment options. Treatment options entail Surgical intervention, Percutaneous ethanol injection, radiofrequency ablation and Radiation Therapy. There are no set guidelines on preference or order of the treatment options. Further, in this review, studies favouring Radiation therapy regimes and their outcomes are elaborated.
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Affiliation(s)
- Shambhavi Sharma
- Department of Radiotherapy, Maulana Azad medical College, New Delhi, India
| | - Rose Kamal
- Department of Radiation Oncology, Amrita Institute of Medical Sciences and Research Centre, Faridabad, Haryana, India
| | - Arun Kumar Rathi
- Department of Radiotherapy, Maulana Azad medical College, New Delhi, India
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Lisitsky IY, Lychagin AV, Zarov AY, Korkunov AL, Cherepanov VG, Vyzankin IA. [Total resection of aggressive hemangioma of thoracic spine: case report and literature review]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:92-97. [PMID: 37325831 DOI: 10.17116/neiro20238703192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The authors report total resection of aggressive hemangioma of Th7 vertebra in a patient with severe conduction disorders in the lower extremities. Total Th7 spondylectomy (Tomita procedure) was performed. This method provided simultaneous en bloc resection of the vertebra and tumor via the same approach, eliminate spinal cord compression and perform stable circular fusion. Postoperative follow-up period was 6 months. Neurological disorders were evaluated using the Frankel scale, pain syndrome - visual analogue scale, muscle strength - MRC scale. Pain syndrome and motor disorders in the lower extremities regressed in 6 months after surgery. CT confirmed spinal fusion without signs of continued tumor growth. Literature data on surgical treatment of aggressive hemangiomas are reviewed.
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Affiliation(s)
- I Yu Lisitsky
- Sechenov First Moscow State Medical University, Russia, Moscow
| | - A V Lychagin
- Sechenov First Moscow State Medical University, Russia, Moscow
| | - A Yu Zarov
- Sechenov First Moscow State Medical University, Russia, Moscow
| | - A L Korkunov
- Sechenov First Moscow State Medical University, Russia, Moscow
| | - V G Cherepanov
- Sechenov First Moscow State Medical University, Russia, Moscow
| | - I A Vyzankin
- Sechenov First Moscow State Medical University, Russia, Moscow
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De Marco R, Piatelli G, Rossi A, Nasto LA, Pavanello M. Stepwise approach for vertebral hemangioma in children: case-reports and treatment algorithm proposal. 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 2022; 31:3748-3758. [PMID: 35608706 DOI: 10.1007/s00586-022-07241-8] [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: 12/18/2021] [Revised: 04/03/2022] [Accepted: 04/20/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To discuss a treatment algorithm for vertebral hemangioma in children. METHODS Vertebral hemangioma (VH) is a rare cause of low back pain in children. In most cases, VHs present as incidental findings and do not require invasive diagnostic procedure. In case of symptomatic presentation, different approaches can be used. Over the years, we have developed a treatment algorithm for VH in children based on our clinical experience. In this manuscript, we propose a stepwise approach to treatment of VHs based on tumor extension and the degree of spinal cord/nerves compression with or without neurological deficit. RESULTS According to the proposed protocol, we discuss two cases of aggressive VH treated at our institution by a multidisciplinary team. The first case is about a young girl treated with percutaneous one-level posterior instrumentation followed by medical adjuvant therapy for an L4 "Stage 3" VH. The second case is about an 8-year-old boy with rapidly progressive myelopathy due to T11 "Stage 4" VH treated with a combined anterior and posterior surgery (i.e., posterior decompression and fusion followed by vertebrectomy and expandable cage placement) after preoperative arterial embolization. CONCLUSION Given the lack of international guidelines and consensus with regard to treatment of VHs in children, we believe our proposal for a stepwise approach combining clinical and radiological characteristics of the lesion may help guide treatment of this condition in children.
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Affiliation(s)
- Raffaele De Marco
- Department of Neurosurgery, IRCCS Istituto "G. Gaslini", via G. Gaslini 5, 16148, Genoa, Italy.
- Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute e Della Scienza" University Hospital, University of Turin, Via Cherasco 15, 10126, Turin, Italy.
| | - Gianluca Piatelli
- Department of Neurosurgery, IRCCS Istituto "G. Gaslini", via G. Gaslini 5, 16148, Genoa, Italy
| | - Andrea Rossi
- Interventional Radiology and Neuroradiology Unit, IRCSS Istituto "G. Gaslini", via G.Gaslini 5, 16148, Genoa, Italy
| | - Luigi Aurelio Nasto
- Department of Paediatric Orthopaedics, IRCCS Istituto "G. Gaslini", via G. Gaslini 5, 16148, Genoa, Italy
| | - Marco Pavanello
- Department of Neurosurgery, IRCCS Istituto "G. Gaslini", via G. Gaslini 5, 16148, Genoa, Italy
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Brindisino F, Scrimitore A, Pennella D, Bruno F, Pellegrino R, Maselli F, Lena F, Giovannico G. Aggressive Vertebral Hemangioma and Spinal Cord Compression: A Particular Direct Access Case of Low Back Pain to Be Managed-A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13276. [PMID: 36293852 PMCID: PMC9603351 DOI: 10.3390/ijerph192013276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Hemangiomas are the most common benign tumours affecting the spine, with an incidence of 10-12% of the general population. Although most hemangiomas are asymptomatic, there are aggressive forms which can develop symptoms, leading patients to show signs of disability. This case report aims to highlight the importance of red flags screening, and to report the physiotherapist's clinical reasoning that led him to refer his patient to other healthcare professionals. This case also illustrated the pre- and post-surgical treatment of a specific low back pain case in a patient affected by aggressive vertebral hemangioma and spinal cord compression. The patient is a 52-year-old man, who reported intense pain in his sacral region about three months prior, which worsened while in sitting position. The physiotherapist proceeded with a complete medical history investigation and clinical examination. After an impaired neurological examination, the patient was referred to another health professional, who diagnosed multiple vertebral hemangiomas in the patient's lumbosacral tract. The therapeutic intervention included the patient's post-surgical rehabilitation following a vascular embolization. This case report shows the importance of proper patient screening. Indeed, during patients' assessment, it is paramount to recognize red flags and to investigate them appropriately. An early referral of patients with conditions that require the support and expertise of other professionals can lead to a timely diagnosis and avoid costly and unnecessary rehabilitation procedures. In this case, the interdisciplinary collaboration between physiotherapist and neurosurgeon was crucial in guiding the patient towards recovery.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Angelo Scrimitore
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Denis Pennella
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Francesco Bruno
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Raffaello Pellegrino
- Antalgic Mini-Invasive and Rehab-Outpatients Unit, Department of Medicine and Science of Aging, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy
- Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano, Switzerland
| | - Filippo Maselli
- Department of Human Neurosciences, University of Rome “Sapienza”, 00185 Rome, Italy
- Sovrintendenza Sanitaria Regionale Puglia INAIL, 70121 Bari, Italy
| | - Francesco Lena
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
- Department of Neurology, IRCCS INM Neuromed, 86077 Pozzilli, Italy
| | - Giuseppe Giovannico
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
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11
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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: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [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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12
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Radiosurgery for benign vertebral body hemangiomas of the spine: a systematic review and meta-analysis. World Neurosurg 2022; 164:97-105. [PMID: 35378316 DOI: 10.1016/j.wneu.2022.03.120] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Spinal vertebral hemangiomas (SVH) are the most common benign tumors of the spine. Here, we performed a systematic review and meta-analysis of radiosurgery (RS) for SVH. METHODS We reviewed manuscripts published between January 1990 and December 2020 on PubMed. Tumor control, pain relief and damage to surrounding tissues were evaluated with separate meta-analyses. This study was performed in accordance with the published Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twenty-three patients with 24 SVH were reported in 3 studies. RESULTS The follow-up ranged from 7.3 months to 84 months. A vast majority of lesions were located at dorsal level (n= 18, 75%). Twenty (83.3%) clinically presented with pain at initial discovery. Complete, partial and stable response after radiations were described in 45.7% (p< 0.001), 23.6% (p= 0.02) and 37.2% (p= 0.7) of the cases. Overall response was described in 94.1% (p= 0.7). No progressive disease was reported. Pain relief was achieved in 87.5% of patients (p= 0.2). Damage to surrounding tissue caused by irradiation was described in 22.3% (p= 0.02) of cases in only one study, in which there were delivered higher doses of radiation. CONCLUSIONS Radiosurgery is safe and effective for SVH. Pain relief in symptomatic patients is extremely high, while local control showed no progressive disease. Damage to surrounding tissues was reported in only one series and included osteitis, osteonecrosis or soft tissue injury after higher radiation doses.
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13
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Pillai SS, Ramsheela PA, Deepak R, Francis S, Jayakrishnan C, Praveen A, Mampally N. Epidural extension of dorsal vertebral D1-D7 hemangiomas with congenital cutaneous hemangiomas: Case report and literature review. Surg Neurol Int 2021; 12:457. [PMID: 34621572 PMCID: PMC8492414 DOI: 10.25259/sni_567_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/28/2021] [Indexed: 11/19/2022] Open
Abstract
Background: There are only rare reports of simultaneous multiple thoracic vertebral, epidural, and congenital cutaneous hemangiomas occurring at the same levels. Case Description: A 24-year-old male presented with a progressive paraparesis attributed to multiple vertebral hemangiomas (MVH) with epidural extension (i.e. resulting in D1–D3 significant cord compression.), plus congenital cutaneous lesions at the D2–D7 levels. Following preoperative angioembolisation, a D1–D7 laminectomy was performed along with a C7–D8 pedicle screw fixation. Pathologically the bone and cutaneous lesions were spinal cavernous hemangiomas. Postoperatively, the patient regained normal function. As complete excision was not feasible, he subsequently received radiotherapy to prevent tumor recurrence. Conclusion: MVH with multilevel epidural extension resulting in significant cord compression and congenital cutaneous lesions should undergo attempted tumor excision followed by radiation therapy where complete removal is not feasible.
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Affiliation(s)
- Suresh S Pillai
- Department of Spine Surgery, Baby Memorial Hospital, Calicut, Kerala, India
| | - P A Ramsheela
- Department of Orthopedics, Baby Memorial Hospital, Calicut, Kerala, India
| | - Rijil Deepak
- Department of Anaesthesia, Baby Memorial Hospital, Calicut, Kerala, India
| | - Shinto Francis
- Department of Hemato-Oncology, Baby Memorial Hospital, Calicut, Kerala, India
| | - C Jayakrishnan
- Neurology, Baby Memorial Hospital, Calicut, Kerala, India
| | - Ani Praveen
- Pathology, Baby Memorial Hospital, Calicut, Kerala, India
| | - Neena Mampally
- Pathology, Baby Memorial Hospital, Calicut, Kerala, India
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14
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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: 7] [Impact Index Per Article: 2.3] [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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15
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Brunette-Clément T, Weil AG, Shedid D. Total en bloc spondylectomy of locally aggressive vertebral hemangioma in a pediatric patient. Childs Nerv Syst 2021; 37:2115-2120. [PMID: 33130918 DOI: 10.1007/s00381-020-04954-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Vertebral hemangiomas are benign, highly vascular spinal lesions that are extremely rare in the pediatric population. We report a pediatric case of symptomatic vertebral hemangioma treated with total en bloc spondylectomy. Our objective is to demonstrate that en bloc spondylectomy is feasible and addresses some pitfalls of traditional total tumor resection. METHODS Our patient presented with bilateral lower limb and perineal paresthesia, paraparesis, as well as urinary retention. Locally aggressive vertebral hemangioma was the presumed diagnosis following imaging. The patient received partial angioembolization to reduce the vascularization of the lesion then underwent total en bloc spondylectomy of T8 under intraoperative neuromonitoring. The intervention was well tolerated. RESULTS Postoperative course was marked by clinical improvement and only transient, treatable complications. On 1-year follow-up, the patient is neurologically intact, and imaging reveals adequate position of hardware, good alignment, and no tumor recurrence. CONCLUSION Total en bloc spondylectomy is a feasible procedure in pediatric patients. It reduces local recurrence through reduction of tumor cell contamination and residual tumor and thus may avoid postoperative radiotherapy in select cases. It may also enhance functional neurological recovery by allowing circumferential decompression and increased spinal cord blood flow.
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Affiliation(s)
- Tristan Brunette-Clément
- Division of Neurosurgery, Sainte-Justine University Hospital Center, 3175, chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - Alexander G Weil
- Division of Neurosurgery, Sainte-Justine University Hospital Center, 3175, chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.
| | - Daniel Shedid
- Division of Neurosurgery, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
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16
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Alves M, Ziegler MS, Dannebrock FA, Zardo EDA, Severo CMD. Hemangioma intraósseo difuso agressivo: Relato de caso. Rev Bras Ortop 2021. [DOI: 10.1055/s-0040-1722585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
ResumoO hemangioma vertebral, um tumor vascular benigno, geralmente é assintomático e descoberto incidentalmente em exames de imagem. Quando sintomático, a apresentação mais frequente ocorre sob a forma de dorsalgia vaga de início insidioso e, em raros casos, pode estar associado a compressão radicular ou medular, causando déficit sensitivo e motor. Os autores relatam o caso de um homem de 33 anos, previamente hígido, com diagnósticos de hemangioma na coluna torácica em múltiplos níveis, no esterno, na escápula e nos arcos costais; todas as lesões eram sintomáticas e houve necessidade de intervenção cirúrgica, sendo que uma das lesões ao nível da coluna torácica evoluiu com compressão medular e déficit neurológico agudo, com necessidade de intervenção cirúrgica de urgência. Os hemangiomas intraósseos representam < 1% de todos os tumores ósseos, e a apresentação multifocal no esqueleto axial e apendicular apresenta poucos relatos. Na revisão bibliográfica, não foi encontrado outro caso de hemangioma intraósseo multifocal agressivo com tal apresentação, inclusive com sintomas neurológicos associados em um mesmo caso.
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Affiliation(s)
- Monique Alves
- Serviço de Ortopedia e Traumatologia, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Marcus Sofia Ziegler
- Serviço de Ortopedia e Traumatologia, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Fernando Augusto Dannebrock
- Serviço de Ortopedia e Traumatologia, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Erasmo de Abreu Zardo
- Serviço de Ortopedia e Traumatologia, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Carlos Marcelo Donazar Severo
- Serviço de Ortopedia e Traumatologia, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
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17
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Shamhoot EA, Balaha AM, Ganna AA. Role of Combined Vertebroplasty and Spinal Decompression in the Management of Aggressive Vertebral Hemangiomas. Asian J Neurosurg 2021; 15:919-925. [PMID: 33708663 PMCID: PMC7869295 DOI: 10.4103/ajns.ajns_291_20] [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: 06/12/2020] [Revised: 08/04/2020] [Accepted: 09/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background: There are different surgical modalities designed to manage aggressive vertebral hemangioma (VH) that causes neurological symptoms. The selection of the best approach is still controversial. It is crucial to safely achieve neurological recovery with the elimination of the risk of recurrence. The combined use of surgical decompression and vertebroplasty is one of the surgical modalities that are used to manage these cases. Patients and Methods: From January 2012 to January 2019, nine patients with aggressive VH were retrospectively included in the study. All of them were operated upon using combined surgical decompression and vertebroplasty. We evaluated all the patients preoperatively, immediate postoperative, 1 month, and 12 months later. Clinical and radiological outcomes were assessed. Results: Affected spinal levels were dorsal in six cases and lumbar in three cases. There was no postoperative worsening of the preoperative neurological status. For the cases presented with sciatica, the mean VAS score has dropped from 8.33 preoperatively to 2.67 postoperatively. One month later, all of them are free from the radicular pain. For the cases presented with myelopathy, they regain their motor power in both lower limbs over a period of 4 weeks with a mean Nurick grade of 1.17. The postoperative radiological studies revealed near total occlusion of the VH with the maintenance of the vertebral body height. No clinical or radiological signs of spinal instability or recurrence are observed over the period of follow-up. Conclusions: The combined use of surgical decompression and vertebroplasty is considered a safe and effective modality in the management of aggressive VHs.
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Affiliation(s)
| | | | - Ahmed Atef Ganna
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Egypt
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18
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Early response assessment after CyberKnife stereotactic radiosurgery for symptomatic vertebral hemangioma by quantitative parameters from dynamic contrast-enhanced MRI. 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; 30:2867-2873. [PMID: 33646419 DOI: 10.1007/s00586-021-06742-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 11/28/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The present study aimed to explore the value of DCE-MRI to evaluate the early efficacy of CyberKnife stereotactic radiosurgery in patients with symptomatic vertebral hemangioma (SVH). METHODS A retrospective analysis of patients with spinal SVH who underwent CyberKnife stereotactic radiosurgery from January 2017 to August 2019 was performed. All patients underwent DCE-MRI before treatment and three months after treatment. The parameters included volume transfer constant (Ktrans), transfer rate constant (Kep), and extravascular extracellular space volume fraction (Ve). RESULTS A total of 11 patients (11 lesions) were included. After treatment, six patients (54.5%) had a partial response, five patients (45.4%) had stable disease, and three patients (27.3%) presented with reossification. Ktrans and Kep decreased significantly in the third month after treatment (p = 0.003 and p = 0.026, respectively). ΔKtrans was -46.23% (range, -87.37 to -23.78%), and ΔKep was -36.18% (range, -85.62 to 94.40%). The change in Ve was not statistically significant (p = 0.213), and ΔVe was -28.01% (range, -58.24 to 54.76%). CONCLUSION DCE-MRI parameters Ktrans and Kep change significantly after CyberKnife stereotactic radiosurgery for SVH. Thus, DCE-MRI may be of value in determining the early efficacy of CyberKnife stereotactic radiosurgery.
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19
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Gupta AK, Phukan P, Bodhey N. Percutaneous vertebroplasty for the treatment of symptomatic vertebral hemangioma with long-term follow-up. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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20
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Konbaz FMS, Al Eissa SI, Alassiri SS, Bourghli A, Abaalkhail MS, Ahmed ME, Al Helal FH, Al Mahayni AO. Hemangioma of the Lumbar Spine Involving the Spinous Process: A Rare Case Report and Review of the Literature. Int J Spine Surg 2021; 14:S57-S65. [PMID: 33900946 DOI: 10.14444/7166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Hemangiomas of the spine are usually benign and asymptomatic. They can cause devastating complications such as pathological fractures of the spine and neurological disability. This report documents an atypical location of a hemangioma in a lumbar spinous process, in combination with a spondylolisthesis at the same level, which makes it even more uncommon. Surgery can be effective and safe and can significantly improve patient outcomes. Moreover, prior embolization can prevent acute hemorrhage in addition to providing careful diagnosis and evaluation.
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21
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Patel S, Ansari D, Patil SN, Burch TG, Chaker AN, Rosinski CL, Chaudhry NS, Mehta AI. High-Grade Spinal Hemangioma: A National Cancer Database Analysis. World Neurosurg 2021; 148:e527-e535. [PMID: 33460817 DOI: 10.1016/j.wneu.2021.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Spinal hemangiomas are common primary tumors of the vertebrae. Although these tumors are most frequently benign and asymptomatic, they can rarely exhibit aggressive growth and invasion into neighboring structures. Treatment for these aggressive variants is controversial, often involving surgery, chemotherapy, and/or radiotherapy. This study sought to investigate current trends affecting overall survival (OS) using the National Cancer Database (NCDB) and to formulate treatment recommendations. METHODS The National Cancer Database was queried for spinal hemangiomas between 2004 and 2016. A Cox proportional hazards model was used to perform multivariate regression analysis of survival. Survival curves for comparative visualization of demographic and treatment factors were generated using a semiparametric Cox approach. RESULTS A cohort of 102 patients with histologically confirmed spinal hemangiomas was identified in the database. Mean OS was 1.94 years. Administered treatments included partial surgical resection (n = 17), radical resection (n = 14), chemotherapy (n = 34), and radiotherapy (n = 56). Multivariate analysis revealed associations between decreased OS and advanced age (>65 years) and presence of metastasis. Cox survival analysis further revealed improved OS in patients who received surgical treatment and higher radiation dose. CONCLUSIONS This retrospective analysis finding that treatment with surgical resection and/or radiotherapy is associated with increased OS constitutes the largest cohort of patients with aggressive vertebral hemangiomas to date. Given that the mean OS of the study cohort was 1.94 years, our findings suggest that the optimal treatment regimen to maximize survival should consist of early surgical resection with adjuvant high-dose radiotherapy.
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Affiliation(s)
- Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Darius Ansari
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Shashank N Patil
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Taylor G Burch
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Anisse N Chaker
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Clayton L Rosinski
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Nauman S Chaudhry
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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22
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LUZ LUCASXAVIERDA, SIMÕES MARCELOSIMONI, OLIVEIRA BRUNODEAZEVEDO, MIOTTO GUILHERMEJOSÉ, ABREU ERNANIVIANNADE. AGGRESSIVE VERTEBRAL HEMANGIOMAS – CASE SERIES AND LITERATURE REVIEW. COLUNA/COLUMNA 2020. [DOI: 10.1590/s1808-185120201904223670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objectives To present a series of aggressive hemangiomas of the institution, with a review of the management options described in the literature. Methods This is a retrospective survey of aggressive vertebral hemangiomas treated by the service in the last 10 years, with histological confirmation of the diagnosis and a minimum follow-up of 1 year. The case analysis and literature review were conducted with emphasis on treatment options for these injuries. Results Seven cases were found, three with pain and four with severe neurological deficits. Two patients were treated with open decompression, one with open decompression and cementation, one with open decompression and arthrodesis, one with biopsy and cementation, one with percutaneous biopsy, and one with open biopsy followed by decompression surgery. All patients underwent radiotherapy. There was a significant regression of presentation deficits, but one patient developed an irreversible deficit during treatment. There were no recurrences or late complications in the follow-up period. Conclusions Surgical decompression in patients with significant neurological deficit is a point of consensus in the literature. Subtotal resection followed by radiation therapy was effective in treating deficits and controlling pathology. Cases manifesting pain only can be managed with minimally invasive techniques, whether or not they are followed by radiotherapy. Level of evidence IV; Therapeutic study of case series.
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23
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Kim CH, Kim SW. Rapidly Progressive Atypical Vertebral Hemangioma: A Case Report. Korean J Neurotrauma 2020; 16:320-325. [PMID: 33163444 PMCID: PMC7607043 DOI: 10.13004/kjnt.2020.16.e24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/01/2020] [Accepted: 07/10/2020] [Indexed: 11/21/2022] Open
Abstract
Vertebral hemangiomas are common, benign, and asymptomatic tumors that rarely extend into the epidural space or involve the posterior elements. Surgery is recommended for aggressive vertebral hemangiomas if symptoms are severe or evolve rapidly. A 57-year-old male patient was admitted to our department for several months of back pain. A computed tomography (CT) scan and magnetic resonance imaging (MRI) were suggestive of T12 hemangioma without the involvement of the spinal canal or posterior elements. Despite aggressive conservative treatments, such as medications or nerve blocks, the back pain worsened. The CT and MRI 2 months later revealed a lesion involving the vertebral body and posterior elements with extension into the epidural space and with spinal cord compression. The patient underwent surgery for bone cement-augmented percutaneous screw fixation followed by low-dose radiotherapy. Histological examination confirmed the diagnosis of atypical hemangioma, specifically an epithelioid hemangioendothelioma.
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Affiliation(s)
- Chi Ho Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Seok Won Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
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24
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Cazzato RL, Garnon J, De Marini P, Auloge P, Dalili D, Koch G, Antoni D, Barthelemy P, Kurtz JE, Malouf G, Feydy A, Charles YP, Gangi A. French Multidisciplinary Approach for the Treatment of MSK Tumors. Semin Musculoskelet Radiol 2020; 24:310-322. [DOI: 10.1055/s-0040-1710052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractSeveral interventional treatments have recently been integrated into the therapeutic armamentarium available for the treatment of bone tumors. In some scenarios (e.g., osteoid osteoma), interventional treatments represent the sole and definitive applied treatment. Due to the absence of widely shared protocols and the complex multivariate scenarios underlying the clinical presentation of the remaining bone tumors including metastases, therapeutic strategies derived from a multidisciplinary tumor board are essential to provide effective treatments tailored to each patient. In the present review, we present the multidisciplinary therapeutic strategies commonly adopted for the most frequent bone tumors.
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Affiliation(s)
- Roberto Luigi Cazzato
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julien Garnon
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierre De Marini
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierre Auloge
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Danoob Dalili
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Nuffield Orthopaedic Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Guillaume Koch
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Delphine Antoni
- Service de Radiothérapie, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Philippe Barthelemy
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Jean Emmanuel Kurtz
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Gabriel Malouf
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Antoine Feydy
- Service de Radiologie, Hôpital Cochin, APHP, Université Paris V, Paris, France
| | - Yan-Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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25
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Bourghli A, Abduljawad SM, BoissiÈre L, Khalifa H, Obeid I. Aggressive Thoracic Hemangioma Leading to Secondary Kyphosis with Paraparesis in the Postpartum Period. A Case Report. Int J Spine Surg 2020; 14:418-425. [PMID: 32699766 DOI: 10.14444/7055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Aggressive vertebral hemangioma is rare, and its management can be very challenging. Methods In this report, we present the case of a 30-year-old female with a normal twin pregnancy. She had been complaining of midthoracic pain after the seventh month of pregnancy with no other symptoms. Normal delivery was done under spinal anesthesia, but the patient's back pain worsened after the delivery, and she left the hospital on Day 4 with the onset of an unsteady gait. She was seen in the spinal clinic on Day 14, referred by her gynecologist, with a paraparetic presentation that was rapidly worsening. Urgent magnetic resonance imaging (MRI) was done and revealed aggressive hemangioma of T6 with kyphosis and significant cord compression. Results The patient was admitted and was operated the following morning. Posterior decompression with fixation from T4 to T8 and kyphosis correction was done. Samples from the vertebrae were sent to the lab for pathology analysis, and the results confirmed the diagnosis of vertebral hemangioma. She could walk on Day 1 with progressive neurological recovery, but distal junctional kyphosis in the form of a "chance fracture" of T8 occurred at 2 months and was treated conservatively. She showed a satisfactory clinical and radiological result at 2 years with no recurrence. Conclusions Literature is sparse on the management of vertebral hemangioma in the context of pregnancy and postpartum, with only case reports, and its presentation as a kyphotic fracture is extremely rare. The current case shows how, in the context of delivery, a benign procedure such as spinal anesthesia should be done with extreme caution, as it may play a role in aggravating an undiagnosed aggressive hemangioma; rapid management after the onset of paraparetic symptoms enables a full neurological recovery, but close monitoring later on with regular MRI is mandatory for detection of any recurrence.
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Affiliation(s)
- Anouar Bourghli
- Orthopaedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Salim M Abduljawad
- Orthopaedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Louis BoissiÈre
- Orthopaedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France
| | - Hani Khalifa
- Obstetrics and Gynecology Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Ibrahim Obeid
- Orthopaedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France
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26
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Corniola MV, Schonauer C, Bernava G, Machi P, Yilmaz H, Lemée JM, Tessitore E. Thoracic aggressive vertebral hemangiomas: multidisciplinary management in a hybrid room. 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 2020; 29:3179-3186. [PMID: 32277334 DOI: 10.1007/s00586-020-06404-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/25/2020] [Accepted: 03/30/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Vertebral hemangiomas (VH) account for 2-3% of all spinal tumors. The majority is incidentally found on radiographic studies: 1% present with pain and/or neurologic deficits. We report our experience with the multidisciplinary management of aggressive symptomatic thoracic VH by concomitant intraoperative sclerotization with sodium tetradecyl sulfate (STS), vertebroplasty, posterior decompression (with/without fusion) and surgical resection in a hybrid operating room (HR) equipped with a rotational scanner and a radiolucent operating table. METHODS Patients admitted with aggressive spinal VH between 2007 and 2018 were included. Data regarding demographics, presenting symptoms, location of the lesion, preoperative embolization, length of the surgery, estimated blood loss (EBL) as well as follow-up (FU) were retrieved. RESULTS Five patients were included (three females, mean age 65 years; range 59-75). Three patients presented with a myelopathy and two mechanical thoracic pain. All patients underwent a single-stage percutaneous sclerotization and vertebroplasty followed by a surgical decompression associated with epidural intralesional injection of STS and subtotal resection of the epidural lesion. Two patients had preoperative embolization. Mean procedural duration was 338 min (range 210-480 min). Four patients had marginal EBL, one patient had 500 ml EBL. Patients had no evidence of lesion recurrence or progression at the end of the follow-up. CONCLUSIONS The single-stage multimodal management of aggressive symptomatic VH is safe and effective. It allows for a direct intraoperative sclerotherapy combined with maximal tumor resection, resulting in reduced blood loss. The use of STS as a direct intraoperative sclerotizing agent is safe and reliable.
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Affiliation(s)
- Marco V Corniola
- Spine Unit, Département Des Neurosciences Cliniques, Service de Neurochirurgie, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Claudio Schonauer
- Neurosurgical Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Gianmarco Bernava
- Neuroradiology Unit, Department of Radiology, Geneva University Hospitals, Geneva, Switzerland
| | - Paolo Machi
- Neuroradiology Unit, Department of Radiology, Geneva University Hospitals, Geneva, Switzerland
| | - Hasan Yilmaz
- Neuroradiology Unit, Department of Radiology, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Michel Lemée
- Spine Unit, Département Des Neurosciences Cliniques, Service de Neurochirurgie, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Enrico Tessitore
- Spine Unit, Département Des Neurosciences Cliniques, Service de Neurochirurgie, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
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Surgical Management of Enneking Stage 3 Aggressive Vertebral Hemangiomas With Neurological Deficit by One-stage Posterior Total En Bloc Spondylectomy: A Review of 23 Cases. Spine (Phila Pa 1976) 2020; 45:E67-E75. [PMID: 31404054 DOI: 10.1097/brs.0000000000003192] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Clinical case series. OBJECTIVE The aim of this study was to describe the treatment of aggressive vertebral hemangiomas (VHs) with neurological deficit treated with total en bloc spondylectomy (TES) in a single institute. SUMMARY OF BACKGROUND DATA Despite increasing utilization of surgery to treat aggressive VHs, owing to the rarity, the diagnosis and treatment protocols of aggressive VHs are still questionable and disputable. METHODS All patients with Enneking stage 3 aggressive thoracic or lumbar VHs with neurological deficit and treated with TES from January 2005 to January 2013 were included. Clinical characteristics and surgery outcomes of patients, including Tomita classification, operation time, blood loss, pre- and postoperative American Spinal Injury Association (ASIA) impairment scale, visual analogue score (VAS), and Spinal Instability Neoplastic Score (SINS), were retrospectively reviewed. RESULTS A total of 23 VHs patients were enrolled in this study, including 17 in the thoracic spine and six in the lumbar spine. All patients suffered neurological deficits caused by direct spinal cord compression with or without associated mechanical instability. The average SINS score was 9.78 ± 1.51. The mean operation time of patients with preoperative embolization was 426.6 ± 104.3 minutes and the mean blood loss was 1883.3 ± 932.1 mL. There were no technical difficulties or serious complications. After surgery, all patients recovered to ASIA-E levels. The VAS pain score decreased from 8.0 ± 0.9 to 2.8 ± 0.8 (P < .05). CONCLUSION TES is a good treatment option for patients with aggressive VHs with bony destruction and neurological deficit. LEVEL OF EVIDENCE 4.
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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.
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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.
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Cox M, Ramchand P, Sedora-Roman NI, Frank DM, Kung D, Pukenas BA. Lymphoma Metastasis to Vertebral Body Hemangioma: Collision Tumor Causing Cord Compression. World Neurosurg 2019; 132:53-56. [PMID: 31470151 DOI: 10.1016/j.wneu.2019.08.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 08/11/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Collision tumors of the spine are extremely uncommon. Prior reports have detailed intracranial collision tumors comprising meningiomas and astrocytomas, as well as metastases to meningiomas. Spinal collision tumors are even rarer, with only 5 cases in the literature, none involving the osseous spine. In this report, we highlight the salient features of a case of lymphoma metastasis to a preexisting benign osseous hemangioma, resulting in cord compression. CASE DESCRIPTION An 81-year-old woman with a known typical T8 vertebral body hemangioma stable for over 6 years was evaluated for increasing back pain, new gait instability, and urinary retention. Magnetic resonance imaging showed a change in the appearance of the T8 hemangioma, with marrow replacement and new associated epidural soft tissue causing cord compression. A biopsy was performed, which showed diffuse large B-cell lymphoma within blood elements, consistent with lymphoma metastasis to a vertebral body hemangioma. The patient was treated with intravenous steroids and radiation therapy. CONCLUSIONS Collision tumors of the spine are extremely rare. New or increasingly aggressive appearance of a previously benign spinal osseous lesion should prompt consideration for a collision tumor or malignant transformation of the benign tumor. Biopsy of the lesion should be strongly pursued whenever feasible, as the treatment strategy may vary depending on the histology of the tumor.
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MESH Headings
- Aged, 80 and over
- Female
- Hemangioma/diagnostic imaging
- Hemangioma/pathology
- Humans
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/pathology
- Neoplasm Metastasis
- Neoplasms, Multiple Primary/complications
- Neoplasms, Multiple Primary/diagnostic imaging
- Neoplasms, Multiple Primary/pathology
- Spinal Cord Compression/etiology
- Spinal Neoplasms/complications
- Spinal Neoplasms/diagnostic imaging
- Spinal Neoplasms/pathology
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Affiliation(s)
- Mougnyan Cox
- Section of Neurointerventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Preethi Ramchand
- Section of Neurointerventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neda I Sedora-Roman
- Section of Neurointerventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dale M Frank
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Kung
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bryan A Pukenas
- Section of Neurointerventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Gajaseni P, Labianca L, Lacerda I, Weinstein S. A Child with a Rare Extraosseous Extension and Pathologic Fracture from a Vertebral Hemangioma: A Case Report. JBJS Case Connect 2019; 7:e86. [PMID: 29286970 DOI: 10.2106/jbjs.cc.17.00057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present a case of a pathologic vertebral fracture and encroachment into the spinal canal from a vertebral hemangioma in a 13-year-old boy. The original approach of embolization followed by an anterior-posterior resection and stabilization through a costotransversectomy had to be converted intraoperatively to a combined anterior and posterior approach secondary to excessive bleeding. CONCLUSION Because of the hypervascularity and the extensive nature of aggressive vertebral hemangiomas, surgeons attempting procedures similar to the case described herein must be prepared to adapt to the circumstances when preoperative embolization is not totally effective. Surgical technique, proper anesthesia, and patient clotting capacity are important factors to consider.
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Affiliation(s)
- Pawin Gajaseni
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,Department of Orthopedics, Phramongkutklao Hospital, Bangkok, Thailand
| | - Luca Labianca
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,Catholic University Sacro Cuore di Gesu, Fondazione Sovena, Rome, Italy
| | - Iara Lacerda
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Stuart Weinstein
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Satti SR, Dua D, Vance AZ. Transpopliteal Access for Intraoperative Spinal Angiography with Combined Percutaneous Treatment of Spinal Hemangioma. Clin Neuroradiol 2018; 29:167-170. [PMID: 29777292 DOI: 10.1007/s00062-018-0696-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 04/26/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Sudhakar R Satti
- Department of Neurointerventional Surgery, Christiana Care Health System, 4755 Ogletown-Stanton Drive, 19718, Newark, DE, USA.
| | - Dharti Dua
- Department of Neurointerventional Surgery, Christiana Care Health System, 4755 Ogletown-Stanton Drive, 19718, Newark, DE, USA
| | - Ansar Z Vance
- Department of Interventional Radiology, Christiana Care Health System, Newark, DE, USA
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Spinal hemangioma mimicking a dumbbell-shaped schwannoma: Case report and review of the literature. J Clin Neurosci 2018; 50:160-162. [DOI: 10.1016/j.jocn.2018.01.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 01/08/2018] [Indexed: 11/22/2022]
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33
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Intérêt d’une prise en charge multimodale des hémangiomes vertébraux symptomatiques : à propos de 27 cas et revue de la littérature. Neurochirurgie 2017; 63:458-467. [DOI: 10.1016/j.neuchi.2017.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 05/10/2017] [Accepted: 08/01/2017] [Indexed: 11/18/2022]
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Oda K, Morimoto D, Kim K, Yui K, Kitamura T, Morita A. Spinal Cavernous Angioma Associated with Klippel-Trenaunay-Weber Syndrome: Case Report and Literature Review. World Neurosurg 2017; 109:333-337. [PMID: 29054771 DOI: 10.1016/j.wneu.2017.10.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Klippel-Trenaunay-Weber syndrome (KTWS) is a rare congenital vascular disorder characterized by the classic triad of cutaneous nevi, venous varicosities, and osseous and soft tissue hypertrophy of the affected limb. Various vascular anomalies of the central nervous system have also been described in patients with KTWS. The English language literature to date contains 6 reports of associations between KTWS and spinal cord cavernous angioma (CA), but management of these patients has not been well described. CASE DESCRIPTION A 23-year-old woman was admitted to our institution with acute onset of leg weakness accompanied by upper back pain. Thoracic magnetic resonance imaging of the spinal cord showed a heterogeneous mass with a slit component at the T1-2 level. The patient underwent left hemilaminectomy followed by removal of the tumor, and her neurologic symptoms improved postoperatively. Pathologic examination showed the spinal lesion was characterized by hemosiderin deposition and thin-walled vascular channels surrounded by fibrous tissue. CONCLUSIONS This is the first report to provide a detailed pathologic description of the features of spinal CA in a patient with KTWS. Assessment of the clinical features and management of CA associated with KTWS are discussed. This syndrome is rare, and further experience in the treatment of these patients is needed. However, considering that the pathologic findings of spinal CA in patients with KTWS include the typical features of CA, the management of CA in patients with KTWS may be identical to management of isolated CA.
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Affiliation(s)
- Kazunori Oda
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
| | - Daijiro Morimoto
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Kyongsong Kim
- Department of Neurosurgery, Chiba Hokusou Hospital, Nippon Medical School, Chiba, Japan
| | - Kanako Yui
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Takao Kitamura
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
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Eichberg DG, Starke RM, Levi AD. Combined surgical and endovascular approach for treatment of aggressive vertebral haemangiomas. Br J Neurosurg 2017; 32:381-388. [DOI: 10.1080/02688697.2017.1344619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Daniel G. Eichberg
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA
| | - Robert M. Starke
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA
| | - Allan D. Levi
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA
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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.
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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
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Zhang HL, Hu YC, Aryal R, He X, Lun DX, Zhao LM. Thoracic Vertebral Hemangioma with Spinal Cord Compression: Multidisciplinary Surgical Treatment and Follow-up of Six Patients. Orthop Surg 2016; 8:462-467. [PMID: 28032698 DOI: 10.1111/os.12293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/29/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To provide useful insights of multidisciplinary surgical treatment for vertebral hemangioma with spinal cord compression. METHODS From 2009 to 2014, data on six patients who were diagnosed with cord compression vertebral hemangioma were reviewed and analyzed retrospectively. There were five women and one man with a mean age of 48.6 years (range, 26-68 years). All the patients were treated by multidisciplinary approach, including use of gelfoam, pedicle screw instrumentation, vertebroplasty, and decompression laminectomy. Neurological status and Frankel grades were documented, CT scan and MRI were performed after surgery. RESULTS The follow-up period ranged from 8 to 54 months. Mean blood loss was around 367 mL, and the mean surgical time was 2.30 h. All patients had uneventful intraoperative and postoperative courses and reported symptomatic and neurological relief to varying degrees, at an average follow-up period of 23 months. Bone cement distribution was disseminated homogeneously over the affected vertebra and no leakage was observed. All the patients had a complete restoration to Frankel grade E. The postoperative and follow-up imaging showed that the implant was in perfect position, and no recurrence occurred in all patients. CONCLUSION The vertebral hemangioma with cord compression is a challenge to surgeons for therapeutic improvement, and an active involvement of several disciplines as well as performance of multidisciplinary surgical treatment can be crucial in achieving favorable results.
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Affiliation(s)
- Hui-Lin Zhang
- Graduate School of Tianjin Medical University, Tianjin Hospital, Tianjin, China.,Department of Bone Oncology, Tianjin Hospital, Tianjin, China
| | - Yong-Cheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
| | - Rajendra Aryal
- Graduate School of Tianjin Medical University, Tianjin Hospital, Tianjin, China.,Department of Bone Oncology, Tianjin Hospital, Tianjin, China
| | - Xin He
- Department of Orthopaedics, Xiqing Hospital, Tianjin, China
| | - Deng-Xing Lun
- Department of Spine Surgery, Weifang People's Hospital, Weifang, Shandong, China
| | - Li-Ming Zhao
- Graduate School of Tianjin Medical University, Tianjin Hospital, Tianjin, China.,Department of Bone Oncology, Tianjin Hospital, Tianjin, China
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Epithelioid hemangioma of bone: a report of two special cases and a literature review. Skeletal Radiol 2016; 45:1723-1727. [PMID: 27660230 DOI: 10.1007/s00256-016-2482-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/16/2016] [Accepted: 09/05/2016] [Indexed: 02/02/2023]
Abstract
Intraosseous epithelioid hemangioma (EH) is a rare intermediate vascular neoplasm, characterized by locally aggressive and rarely metastasizing behavior. Occasionally, EH of bone can behave strangely and may simulate malignant neoplasm. Here, we report two cases of EH of bone. Of interest was the fact that the computed tomography and magnetic resonance images from one case showed an osteolytic lesion in the right scapula, with multiple swollen lymph nodes in the right supraclavicular and axillary areas. Another patient exhibited a local recurrence in the cervical vertebrae. The initial radiological diagnosis of both cases was metastatic tumor. EH should be included in the differential diagnosis of a radiographic osteolytic lesion with an aggressive appearance. Also, we reviewed the literature that reported EH of bone and summarized their radiological appearances. The cases of EH of bone that exhibited involvement of regional or draining lymph nodes were also summarized.
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A case report of spondylectomy with circumference reconstruction for aggressive vertebral hemangioma covering the whole cervical spine (C4) with progressive spinal disorder. 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 2016; 26:69-74. [PMID: 27613010 DOI: 10.1007/s00586-016-4765-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/11/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe the surgical experience of spondylectomy and spinal reconstruction for aggressive vertebral hemangioma (VH) induced at the C4 vertebra. No reports have described surgical strategy in cases covering an entire cervical vertebra presenting with progressive myelopathy. METHODS A 28-year-old man presented with rapidly progressing skilled motor dysfunction and gait disorder. The Japanese Orthopedic Association (JOA) score was 6. Radiography showed a honeycomb appearance for the entire circumference of the C4 vertebra. Spinal computed tomography and magnetic resonance imaging showed vertebral tumor with extraosseous extension causing spinal cord compression. Results of diagnostic imaging were strongly suggestive of VH. Transarterial embolization of the spinal body branch was performed first to decrease intraoperative bleeding, followed by cervical posterior fixation to stabilize the unstable segment and excision biopsy to obtain a definitive diagnosis. After definitive diagnosis of cavernous hemangioma, two-stage surgery (anterior and posterior) was performed to complete total spondylectomy and 360° spinal reconstruction. RESULTS Despite multiple operations, JOA scores were 8.5 after posterior fixation, 10.5 after anterior surgery, 11 after final surgery and 16 on postoperative day 90. The patient acquired excellent clinical results without complications and returned to society. CONCLUSIONS The present three-stage surgery comprising fixation, biopsy, and final spondylectomy with circumferential fusion from anterior and posterior approaches may offer a useful choice for aggressive VH covering the entire cervical spine with rapidly progressive myelopathy.
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Cañete AN, Bloem H, Kroon H. Tumores primarios de columna. RADIOLOGIA 2016; 58 Suppl 1:68-80. [DOI: 10.1016/j.rx.2016.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 12/17/2015] [Accepted: 01/05/2016] [Indexed: 11/26/2022]
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Jalaeikhoo H, Ariana M, Kashfi SMH, Azimzadeh P, Narimani A, Dadpay M, Keyhani M. Coexistence of splenic hemangioma and vascular malformation of the vertebrae. BMC Res Notes 2016; 9:76. [PMID: 26860733 PMCID: PMC4748470 DOI: 10.1186/s13104-016-1860-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 01/14/2016] [Indexed: 11/25/2022] Open
Abstract
Background Cavernous hemangioma is an encapsulated mass of dilated, endothelial lined vascular channels filled with slowly flowing blood. Cavernous hemangioma of the spleen is a rare condition with less than 100 reports so far. Hemangioma of the vertebral is a benign vascular legion around one or two vertebrae. These are usually asymptomatic and discovered incidentally. In this study we reported an extreme rare case of splenic hemangioma coexistence with vascular malformation of the vertebrae. To our knowledge this is the first report of coexistence of splenic hemangioma and hemangioma of the vertebra. Case presentation A 20-year-old iranian male with splenomegaly, abdominal pain, diarrhea and pancytopenia who was first highly suspicious for malignancy referred to our center for evaluation of the diagnostic workup. After full examination we detected a very rare case with a giant, solitary cavernous hemangioma of the spleen and multiple hemangiomas in his vertebrae. Histopathology of the spleen showed a large cavernous hemangioma occupying almost the entire spleen with large areas of infarction necrosis with multiple hemangiomas of the vertebrae. Conclusion It is extremely rare to have a splenic hemangioma concurrent with vertebra hemangioma and this is clinically very important to consider splenic hemangioma in differential diagnosis of splenomegaly for a better therapeutic management in related patients.
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Affiliation(s)
- Hasan Jalaeikhoo
- AJA Cancer Research Center (ACRC), AJA University of Medical Sciences, Tehran, Iran.
| | - Mehdi Ariana
- AJA Trauma and Surgery Research Center, AJA University of Medical Sciences, Tehran, Iran.
| | - Seyed Mohammad Hossein Kashfi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Pedram Azimzadeh
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ahmad Narimani
- AJA Cancer Research Center (ACRC), AJA University of Medical Sciences, Tehran, Iran.
| | - Masoomeh Dadpay
- AJA Cancer Research Center (ACRC), AJA University of Medical Sciences, Tehran, Iran.
| | - Manouchehr Keyhani
- Hematology and Oncology Research Center, Vali Asr Hospital, Tehran University of Medical Science, Tehran, Iran.
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Grelat M, Madkouri R, Tremlet J, Thouant P, Beaurain J, Mourier KL. Aim and indications of spinal angiography for spine and spinal cord surgery: Based on a retrospective series of 70 cases. Neurochirurgie 2016; 62:38-45. [DOI: 10.1016/j.neuchi.2015.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 09/11/2015] [Accepted: 10/10/2015] [Indexed: 11/29/2022]
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Weaver SM, Kumar AB. Epithelioid hemangioma of the spine: an uncommon cause of spinal cord compression. Acta Neurol Belg 2015; 115:843-5. [PMID: 25672266 DOI: 10.1007/s13760-015-0437-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 01/25/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Sheena M Weaver
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - Avinash B Kumar
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN, 37212, USA.
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McEvoy SH, Farrell M, Brett F, Looby S. Haemangioma, an uncommon cause of an extradural or intradural extramedullary mass: case series with radiological pathological correlation. Insights Imaging 2015; 7:87-98. [PMID: 26385689 PMCID: PMC4729714 DOI: 10.1007/s13244-015-0432-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/17/2015] [Accepted: 09/03/2015] [Indexed: 12/24/2022] Open
Abstract
Abstract Haemangiomas of the vertebrae, usually regarded as having little or no consequence, may display aggressive features, including extension into the extradural space, and cause significant neurological symptoms and signs necessitating treatment. Extraosseous haemangiomas in an extradural or intradural extramedullary location are a rare entity. Here we review our radiologic and pathologic experience of osseous haemangiomas with extradural extension and primary extradural and intradural extramedullary haemangiomas. Magnetic resonance imaging plays a pivotal role in the characterisation of spinal haemangiomas, with typical imaging features including T1 and T2 signal hyperintensity. Atypical and aggressive imaging features are also described. Spinal angiography may be required to differentiate haemangiomas from non-vascular lesions. This is a rare and unusual entity, and should be considered as a differential diagnosis for some extramedullary masses. Teaching points • Osseous haemangiomas can display aggressive features and cause neurologic symptoms needing treatment. • Haemangioma extension into the extradural space is an imaging feature of aggressiveness. • Extraosseous haemangiomas are a rare but important differential diagnosis for extramedullary masses. • Extraosseous extramedullary haemangiomas most frequently present with progressive myelopathy. • MRI is pivitol in characterising spinal haemangiomas; imaging characteristics can vary.
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Affiliation(s)
- S H McEvoy
- Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland.
| | - M Farrell
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - F Brett
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - S Looby
- Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland
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Staikou C, Stamelos M, Boutas I, Koutoulidis V. Undiagnosed vertebral hemangioma causing a lumbar compression fracture and epidural hematoma in a parturient undergoing vaginal delivery under epidural analgesia: a case report. Can J Anaesth 2015; 62:901-6. [DOI: 10.1007/s12630-015-0381-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 04/01/2015] [Indexed: 11/29/2022] Open
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Total en bloc spondylectomy for locally aggressive vertebral hemangioma causing neurological deficits. Case Rep Orthop 2015; 2015:724364. [PMID: 25918662 PMCID: PMC4397049 DOI: 10.1155/2015/724364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 03/22/2015] [Indexed: 12/24/2022] Open
Abstract
Vertebral hemangiomas are common; however, aggressive vertebral hemangiomas with extraosseous extensions causing neurological deficits are rare. The treatment for this subtype of hemangioma remains controversial, since there are few reports on long-term clinical outcomes or tumor recurrence rates. We describe a case of aggressive vertebral hemangioma treated by total en bloc spondylectomy, with a literature review focusing on long-term recurrence. A 52-year-old male with a two-month history of numbness in the bilateral lower extremities was referred to our hospital. Imaging studies showed a tumor originating in the T9 vertebra and extending to the T8 and T10 vertebrae, with extraosseous extension causing spinal-cord compression. Ten months after onset, the patient presented with progressive paraparesis and hypalgesia. Total en bloc spondylectomy was performed, and pathology was consistent with cavernous hemangioma. Motor and sensory deficits improved significantly, and no signs of recurrence are seen at 2.5 years after operation. A review of literature revealed a recurrence rate of 12.7% (10/79 cases). The available evidence indicates satisfactory long-term outcomes for total tumor resection without adjuvant radiotherapy.
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DEGRO guidelines for the radiotherapy of non-malignant disorders. Strahlenther Onkol 2015; 191:541-8. [DOI: 10.1007/s00066-015-0818-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/23/2015] [Indexed: 12/11/2022]
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Li K, Yan J, Yang Q, Li Z, Li J. The effect of void creation prior to vertebroplasty on intravertebral pressure and cement distribution in cadaveric spines with simulated metastases. J Orthop Surg Res 2015; 10:20. [PMID: 25626462 PMCID: PMC4338624 DOI: 10.1186/s13018-015-0160-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/07/2015] [Indexed: 11/19/2022] Open
Abstract
Background For osteoporosis or spinal metastases, percutaneous vertebroplasty is effective in pain relief and improvement of mobility. However, the complication rate (cement extravasation and fat embolisms) is relatively higher in the treatment of spinal metastases. The presence of tumor tissue plays a significant role in intravertebral pressure and cement distribution and thereby affects the occurrence of complications. We investigated the effect of void creation prior to vertebroplasty on intravertebral pressure and cement distribution in spinal metastases. Methods Eighteen vertebrae (T8–L4) from five cadaveric spines were randomly allocated for two groups (group with and without void) of nine vertebrae each. Defect was created by removing a central core of cancellous bone in the vertebral body and then filling it with 30% or 100% fresh muscle paste by volume to simulate void creation or no void creation, respectively. Then, 20% bone cement by volume of the vertebral body was injected into each specimen through a unipedicular approach at a rate of 3 mL/min. The gender of the donor, vertebral body size, bone density, cement volume, and intravertebral pressure were recorded. Then, computed tomography scans and cross sections were taken to evaluate the cement distribution in vertebral bodies. Results No significant difference was found between the two groups in terms of the gender of the donor, vertebral body size, bone density, or bone cement volume. The average maximum intravertebral pressure in the group with void creation was significantly lower than that in the group without void creation (1.20 versus 5.09 kPa, P = 0.001). Especially during the filling of void, the difference was more pronounced. Void creation prior to vertebroplasty allowed the bone cement to infiltrate into the lytic defect. Conclusions In vertebroplasty for spinal metastases, void creation produced lower intravertebral pressure and facilitated cement filling. To reduce the occurrence of complication, it may be an alternative to eliminate the tumor tissue to create a void prior to cement injection.
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Affiliation(s)
- Ka Li
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China.
| | - Jun Yan
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China.
| | - Qiang Yang
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China.
| | - Zhenfeng Li
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China.
| | - Jianmin Li
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China.
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Concomitant intramedullary arteriovenous malformation and a vertebral hemangioma of cervical spine discovered by a pathologic fracture during bicycle accident. 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 2014; 24:187-92. [PMID: 25351839 DOI: 10.1007/s00586-014-3620-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 10/06/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Spinal intramedullary arteriovenous malformations are uncommon and a challenging type of neurosurgical entities. They are rarely located to cervical segment. On the other hand, although hemangiomas are relatively common bone tumors, cervical involvement is again rare and clinically significant ones are infrequent. CASE PRESENTATION A 14 year-old-male patient referred to an academic tertiary care unit and presented with neck pain and left hand weakness. Neurological examination revealed motor strength deficit at intrinsic muscles and hyperesthesia at the left hand. Furthermore the pathological reflexes were positive on the left hand side. Imaging studies showed compression fracture, lytic changes resembling a hemangioma at C7 vertebra, and also an intramedullary vascular pathology at C5-6 level which was shown to be an intradural-intramedullary arteriovenous malformation (AVM) on digital subtraction angiography. Based on neurological and radiological findings, the decision was to treat the patient. After embolization of the AVM, the neurological condition of the patient deteriorated and immediate MRI scan of the cervical spine revealed edema of the spinal cord at the C5-6 level. Thus an emergent surgery was performed and C5-6-7 laminectomies with C5-T2 posterior fixation and arthrodesis were implemented. A second stage operation was carried out as C7 corpectomy with a distractable titanium cage 2 weeks after initial surgery. A follow-up evaluation at five years revealed 4/5 motor strength on his left intrinsic hand muscles and mild hyperactive deep tendon reflexes. Imaging studies at the postoperative period showed stable placement of the construct and no evidence of contrast enhancement at the C5-6 level inside the spinal cord. CONCLUSION A rare case of multiple pathologies affecting the cervical spine, coincidentally diagnosed after a pathological fracture during a bicycle accident as vertebral hemangioma and intradural-intramedullary AVM that was successfully treated with early detection, have been presented. One should assess such patients under multidisciplinary fashion and treat on a case-by-case basis for achieving the best results in patient care.
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Two-stage surgical management of multilevel symptomatic thoracic haemangioma using ethanol and iliac crest bone graft. Asian Spine J 2014; 8:502-5. [PMID: 25187869 PMCID: PMC4149995 DOI: 10.4184/asj.2014.8.4.502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 10/15/2013] [Accepted: 11/13/2013] [Indexed: 11/11/2022] Open
Abstract
This article presents a 56-year-old obese female who presented with back pain and progressive weakness in her lower limbs for three months. She was bed-ridden for one week before reporting to our hospital. Plain radiographs showed vertical striations in multiple vertebrae classical of haemangioma. Magnetic resonance imaging (MRI) spine revealed multiple thoracic and lumbar vertebral haemangiomas. Extra osseous extension of haemangioma at T12 was causing spinal cord compression. Two-stage surgery was performed with absolute alcohol (ethanol) injection followed by pedicle screw fixation and decompression with tricortical iliac crest bone graft into the vertebral body. Postoperatively rapid neurological improvement was seen. After three weeks, she could walk independently. One year later, computed tomography showed complete incorporation of bone graft and maintained vertebral body height. MRI showed complete resolution of the cord edema at T12. These findings indicated diminished vascularity of the tumor.
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