Utility of spinal angiography and arterial embolization in patients undergoing CT guided alcohol injection of aggressive vertebral hemangiomas

Abstract Background:In rare instances, aggressive vertebral hemangiomas (VHs) can cause compression fracture, resulting in severe pain and neurological deficits. But the diagnosis and treatment of these aggressive lesions are challenging because of these lesions are rare and atypical. This study aimed to evaluate the safety and efficacy of surgical management for aggressive VHs with vertebral compression fracture by a modified multimodality surgery.Methods:We retrospectively reviewed 6 cases suffering from aggressive VHs with compression fracture and neurological deficits in our department from July 2011 to April 2016. These patients were treated by the multimodality surgery, includingpreoperative embolization, intraoperative injection of gelfoam mixed with cement, and laminectomy decompression.The follow-up period was at least 3 years. Perioperative parameters, clinical outcomes, and radiographical data were collected and analyzed.Results: The 6 patients involved 1 male and 5 females (mean age, 52.3 years).The levels involved were: in thoracic spine (5 cases) and lumbar spine (1 case).Preoperative CT-guided biopsy was conducted in all patients, with 5 patients had definitive pathologic diagnosis. All patients were treated successfully with the multimodal surgery, with no cement leakage and other severe complications. The mean operation time was 182.2 minutes, and the estimated blood loss was 908.3 ml.At an average follow-up of 49.8 months, clinical outcomes assessed by the visual analogue scale and Frankel grade were significantly improved. The vertebral body height and kyphosis angle of the fractured vertebra were also corrected postoperatively. No affected vertebra re-fracture and adjacent vertebral fracture were developed, and none of the patients experienced recurrence of tumor at final follow-up.Conclusions:In cases of aggressive VHs causing compression fracture with neurological deficits, CT-guided biopsy is indicated for the diagnosis. The multimodality surgery (preoperative embolization, intraoperative injection of gelfoam mixed with bone cement combined laminectomy decompression) is effective and safe, and can be considered as an acceptable surgical choice.

Download Full-text

Treatment of Vertebral Hemangiomas With Absolute Alcohol (Ethanol) Embolization, Cord Decompression, and Single Level Instrumentation: A Pilot Study

Neurosurgery ◽

10.1227/neu.0b013e3181fc60e9 ◽

2011 ◽

Vol 68 (1) ◽

pp. 78-84 ◽

Cited By ~ 16

Author(s):

Pankaj. Singh ◽

Nalin K. Mishra ◽

Hari Har. Dash ◽

Rajender K. Thyalling ◽

Bhawani S. Sharma ◽

...

Keyword(s):

Spinal Injury ◽

Pedicle Screws ◽

Cord Compression ◽

Absolute Alcohol ◽

Alcohol Injection ◽

Instrumented Fusion ◽

Single Level ◽

Vertebral Hemangiomas ◽

Ethanol Embolization

Abstract BACKGROUND: Vertebral hemangiomas (VH) are the most common lesions of the vertebral column. OBJECT: To evaluate the role of intraoperative ethanol embolization, surgical decompression, and instrumented fusion in VH presenting with myelopathy. METHODS: This is was a prospective study of single-level symptomatic VH with cord compression. Exclusions were as follows: pathological fractures, deformity, or multilevel pathologies. Surgery consisted of intraoperative bilateral pedicular absolute alcohol injection and laminectomy at the level of pathology followed by a short-segment instrumented fusion using pedicle screws. RESULTS: Ten patients (mean, 26.8 ± 18.11; range, 10-68 years; 8 females) were treated with use of this technique. Clinical features included myelopathy with motor and sensory involvement in all (4 paraplegic), sphincter involvement (8), and severe local pain (5). The preoperative American Spinal Injury Association (ASIA) scores were A (3), B (1), and C (6). All had pan vertebral body VH with severe cord compression. The mean surgical time was 102 ± 22 minutes; average blood, 296 ± 90.82 mL. Mean amount of absolute alcohol injected was 12.6 ± 4.7 mL (1 requiring 25 mL). Immediate embolization was achieved in all patients allowing laminectomy and soft-tissue hemangioma removal. Postsurgery, all patients showed improvement (sphincters improved in 4) at a follow-up ranging 12 to 26 months (transient neurological deterioration in 1). Postsurgery ASIA scores were D (5) and E (5) at last follow-up. Two patients showed evidence of bone sclerosis on follow-up CT scans at 1.2 and 1.5 years. CONCLUSION: This procedure seems to be a safe, efficient method to treat VH with severe cord compression. It seems to serve the purpose of providing embolization, cord decompression, and rigid fusion at the same sitting.

Download Full-text

Complications associated with percutaneous nephrolithotripsy: supra- versus subcostal access: A retrospective study

Acta Radiologica ◽

10.1080/j.1600-0455.2003.00083.x ◽

2003 ◽

Vol 44 (4) ◽

pp. 447-451 ◽

Cited By ~ 1

Author(s):

E. Radecka ◽

M. Brehmer ◽

K. Holmgren ◽

A. Magnusson

Keyword(s):

Retrospective Study ◽

Urinary Calculi ◽

Arterial Embolization ◽

Fluoroscopic Guidance ◽

Ct Guided ◽

Number Of Patients ◽

Increased Risk ◽

Significant Difference ◽

The Difference ◽

Percutaneous Nephrolithotripsy

Purpose: Percutaneous nephrolithotripsy is an essential procedure for treating complex urinary calculi. To achieve optimal access to a large and complicated stone, an upper calyx puncture is often preferable. However, when performing a puncture above the 12th rib there is risk of an increased number of complications. In this retrospective study, we assessed the kind and frequency of complications after sub- and supracostal punctures of the collecting system of the kidney. Material and Methods: Between 1996 and 2001, 85 patients were treated with percutaneous nephrolithotripsy. In 63 patients a subcostal track, below the 12th rib was established. Puncture was performed under ultrasonic or fluoroscopic guidance in 61 patients and CT-guided in 2 patients. In 17 patients a supracostal puncture, above the 12th rib, was performed under CT guidance and in 5 patients with US or fluoroscopic guidance. Result: The main difference regarding preoperative complications was the number of patients complaining of respiratory correlated pain, 7 (32%) in the supracostal puncture group compared with 3 (5%) in the subcostal puncture group. No significant difference regarding peroperative complications was found. Postoperatively, there were 2 major bleedings, one in each group, which had to be treated with arterial embolization. In the supracostal puncture group there were 2 patients with pleural effusion and 2 patients with pneumothorax. Conclusion: The complication rate was slightly higher after supracostal puncture as compared with a subcostal approach, especially regarding respiratory correlated pain. When performing a supracostal puncture there is an increased risk that the track passes through the pleural space, which might explain the difference in the panorama of complications.

Download Full-text

Vertebrectomy for treatment of vertebral hemangioma without preoperative embolization

Journal of Neurosurgery ◽

10.3171/jns.1986.65.3.0404 ◽

1986 ◽

Vol 65 (3) ◽

pp. 404-406 ◽

Cited By ~ 32

Author(s):

Tony Feuerman ◽

Paul S. Dwan ◽

Ronald F. Young

Keyword(s):

Arterial Embolization ◽

Preoperative Embolization ◽

Vertebral Hemangioma ◽

Transthoracic Approach ◽

Tumor Vessels ◽

Content Type ◽

Vertebral Hemangiomas ◽

Postoperative Improvement ◽

Fine Print

✓ Vertebral hemangiomas have usually been treated by resection following preoperative arterial embolization. A case is presented in which no feeding tumor vessels were demonstrable angiographically. The tumor was resected by an arterolateral transthoracic approach without preoperative embolization. There was progressive postoperative improvement of the myelopathy.

Download Full-text

Aggressive Vertebral Hemangioma Causing Recurring Myelopathy – A Rare Case Report and Review of Literature

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i06.2240 ◽

2021 ◽

Vol 11 (6) ◽

Author(s):

Rohan Bharat Gala ◽

Sanjay B Dhar ◽

Sachin Y Kale ◽

Raja Ganesh ◽

Aditya A Dahapute

Keyword(s):

Case Report ◽

Lower Limb ◽

Arterial Embolization ◽

Surgical Decompression ◽

Vertebral Hemangioma ◽

Left Lower Limb ◽

The Right ◽

Compressive Myelopathy ◽

Vertebral Hemangiomas

Introduction: Vertebral hemangiomas although benign vascular lesions few of these may be ag-gressive causing osseous, extra-osseous and/or epidural expansions with recurrence rate as low as 3%. It should be considered as one of the important differentials while dealing with lytic lesions in the dorsal spine causing compressive myelopathy. Case Report: A 16-year-old female came with an acute history of paraparesis with bladder in-volvement. She was diagnosed of vertebral hemangioma of D9 for which she underwent surgical decompression and fixation. At present, she had paraparesis with a sensory level of D10 on exami-nation. After radiological investigations (X-ray and MRI) she had high intensity signals in the extra osseous portion of D9 with significant neural compression indicating recurrence of vertebral he-mangioma. She underwent decompression with long segment instrumentation with prior arterial embolization. Histopathology features were suggestive of hemangioma and our diagnosis of recur-rence was confirmed. At 2 weeks, the patient had improved neurology with partial sensory recovery and Grade 2 power in the right lower limb and Grade 1 power in the left lower limb. Histopathology report confirmed the diagnosis of hemangioma indicating recurrence. At 6 months follow-up after aggressive rehabilitation, the patient was spastic and improved to Grade 3 power in the left lower limb and Grade 4 power in the right lower limb. The sphincteric control was also found to be fair at 1 year follow-up. Discussion: Vertebral hemangiomas when causing progressive neurological deficit warrant surgical decompression. The choice of intervention depends on location and extent of the tumor. Due to their high vascularity, it is advisable for to preoperatively carry out arterial embolization. Conclusion: Although commonly asymptomatic, vertebral hemangiomas may present as compressive myelopathy. Therefore, they should be detected early, intervened and followed up regularly to detect re

Download Full-text