Vertebral Body Infarction after Transarterial Preoperative Embolization of a Vertebral Hemangioma

Abstract Background Vertebral hemangioma resection can be a real challenge for spine surgeons, given the high potential of massive intraoperative bleeding. For this reason, preoperative transarterial embolization of this tumor is supported by the available literature. Here, we discuss our difficulties in interpreting an unusual clinical and radiologic picture related to the endovascular procedure. Methods and Results A 45-year-old man was referred to our department due to chronic back pain and progressive lower extremity weakness. Radiologic assessment was obtained by means of spinal computed tomography (CT) and magnetic resonance imaging (MRI), which showed an aggressive vertebral hemangioma in T7, compressing the spinal cord. The patient underwent a combined therapeutic approach consisting of preoperative transarterial embolization followed by tumor resection, spinal cord decompression, and posterior thoracic arthrodesis. The patient was dismissed with neither strength nor sensory deficits. Two weeks later, he returned to our department with fever. A new MRI demonstrated multiple areas of altered signal in almost all vertebral bodies from T6 down to the sacrum. After a deep diagnostic process, including new MRI and infectious disease evaluations, the definitive diagnosis of multiple vertebral bone infarction was suggested. Conclusion Vertebral infarctions are an extremely rare complication of spinal endovascular procedures. To our knowledge, this is the first case of multiple postembolization vertebral infarctions, without spinal cord involvement. This peculiarity was explained by the presence of direct anastomoses between a posterior intercostal artery and the underlying vertebral bodies.

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Symptomatic vertebral hemangiomas during pregnancy

Journal of Neurosurgery Spine ◽

10.3171/2014.2.spine13593 ◽

2014 ◽

Vol 20 (5) ◽

pp. 585-591 ◽

Cited By ~ 9

Author(s):

Alexis Moles ◽

Olivier Hamel ◽

Christophe Perret ◽

Eric Bord ◽

Roger Robert ◽

...

Keyword(s):

Spinal Cord ◽

The Body ◽

Medical Emergency ◽

Vascular Tumors ◽

Posterior Arch ◽

Vertebral Hemangioma ◽

Review Of The Literature ◽

Spontaneous Fracture ◽

First Case ◽

Vertebral Hemangiomas

Symptomatic vertebral hemangiomas during pregnancy are rare, as only 27 cases have been reported in the literature since 1948. However, symptomatic vertebral hemangiomas can be responsible for spinal cord compression, in which case they constitute a medical emergency, which raises management difficulties in the context of pregnancy. Pregnancy is a known factor responsible for deterioration of these vascular tumors. In this paper, the authors report 2 clinical cases of symptomatic vertebral hemangiomas during pregnancy, including 1 case of spontaneous fracture that has never been previously reported in the literature. The authors then present a brief review of the literature to discuss emergency management of this condition. The first case was a 28-year-old woman at 35 weeks of gestation, who presented with paraparesis. Spinal cord MRI demonstrated a vertebral hemangioma invading the body and posterior arch of T-3 with posterior epidural extension. Laminectomy and vertebroplasty were performed after cesarean section, allowing neurological recovery. The second case involved a 35-year-old woman who presented with spontaneous fracture of T-7 at 36 weeks of gestation, revealing a vertebral hemangioma with no neurological deficit, but it was responsible for pain and local instability. Treatment consisted of postpartum posterior interbody fusion. With a clinical and radiological follow-up of 2 years, no complications and no modification of the hemangiomas were observed. A review of the literature reveals discordant management of these rare cases, which is why the treatment course must be decided by a multidisciplinary team as a function of fetal gestational age and maternal neurological features.

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Three-dimensional printing-assisted anterior and posterior combined surgery for treating a giant aggressive vertebral hemangioma

Journal of International Medical Research ◽

10.1177/03000605211068686 ◽

2022 ◽

Vol 50 (1) ◽

pp. 030006052110686

Author(s):

Jing-Li Liu ◽

Xin-Gen Liao ◽

Xi-An Dai ◽

Ji-Huan Zeng ◽

Liang Deng ◽

...

Keyword(s):

Spinal Cord ◽

3D Printing ◽

Neck Pain ◽

Three Dimensional ◽

Vertebral Hemangioma ◽

Combined Surgery ◽

Three Dimensional Printing ◽

Imaging Examination ◽

Vertebral Bodies ◽

Dimensional Printing

Aggressive vertebral hemangioma (AVH) is a type of non-neoplastic and congenital developmental abnormality of spinal cord blood vessels. We report the innovative application of three-dimensional (3D) printing-assisted anterior and posterior combined surgery for treating a giant AVH. This could be a novel treatment in the future. A 44-year-old man suffered from persistent neck pain and limited limb mobility for approximately 2 weeks. An imaging examination showed the destruction of C2–4 vertebral bodies, and a giant lesion invaded the spinal cord. He underwent 3D printing-assisted anterior and posterior combined surgery. Postoperatively, his symptoms of persistent neck pain and limited limb mobility were alleviated. An imaging examination showed that internal fixation and the prosthesis were fixed in place, and the spinal canal was unobstructed. Treating a giant AVH by 3D printing-assisted anterior and posterior combined surgery is feasible and effective.

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Preoperative embolization and intraoperative cryocoagulation as adjuncts in resection of hypervascular lesions of the thoracolumbar spine

Journal of Neurosurgery Spine ◽

10.3171/spi.2002.97.3.0294 ◽

2002 ◽

Vol 97 (3) ◽

pp. 294-300 ◽

Cited By ~ 6

Author(s):

Remi Nader ◽

Brent T. Alford ◽

Haring J. W. Nauta ◽

Wayne Crow ◽

Eric Vansonnenberg ◽

...

Keyword(s):

Spinal Cord ◽

Tumor Resection ◽

Thoracolumbar Spine ◽

Spinal Tumors ◽

Preoperative Embolization ◽

Physical Separation ◽

Content Type ◽

Spinal Reconstruction ◽

Estimated Blood Loss ◽

Fine Print

Object. The purpose of this study was twofold. First the authors evaluated preoperative embolization alone to reduce estimated blood loss (EBL) when resecting hypervascular lesions of the thoracolumbar spine. Second, they compared this experience with intraoperative cryotherapy alone or in conjunction with embolization to minimize further EBL. Methods. Twelve patients underwent 13 surgeries for hypervascular spinal tumors. In 10 cases the surgeries were augmented by preoperative embolization alone. In one patient, two different surgeries involved intraoperative cryocoagulation, and in one patient surgery involved a combination of preoperative embolization and intraoperative cryocoagulation for tumor resection. When cryocoagulation was used, its extent was controlled using intraoperative ultrasonography or by establishing physical separation of the spinal cord from the tumor. In the 10 cases in which embolization alone was conducted, intraoperative EBL in excess of 3 L occurred in five. Mean EBL was of 2.8 L per patient. In one patient, who underwent only embolization, excessive bleeding (> 8 L) required that the surgery be terminated and resulted in suboptimum tumor resection. In another three cases, intraoperative cryocoagulation was used alone (in two patients) or in combination with preoperative embolization (in one patient). In all procedures involving cryocoagulation of the lesion, adequate hemostasis was achieved with a mean EBL of only 500 ml per patient. No new neurological deficits were attributable to the use of cryocoagulation. Conclusions. Preoperative embolization alone may not always be satisfactory in reducing EBL in resection of hypervascular tumors of the thoracolumbar spine. Although experience with cryocoagulation is limited, its use, in conjunction with embolization or alone, suggests it may be helpful in limiting EBL beyond what can be achieved with embolization alone. Cryocoagulation may also assist resection by preventing spillage of tumor contents, facilitating more radical excision, and enabling spinal reconstruction. The extent of cryocoagulation could be adequately controlled using ultrasonography or by establishing physical separation between the tumor and spinal cord. Additionally, somatosensory evoked potential monitoring may provide early warning of spinal cord cooling.

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A new fiber-mediated carbon dioxide laser facilitates pediatric spinal cord detethering

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.4.peds08349 ◽

2009 ◽

Vol 4 (3) ◽

pp. 280-284 ◽

Cited By ~ 19

Author(s):

Samuel R. Browd ◽

Jacob Zauberman ◽

Mahesh Karandikar ◽

Jeffery G. Ojemann ◽

Anthony M. Avellino ◽

...

Keyword(s):

Spinal Cord ◽

Carbon Dioxide Laser ◽

Laser Energy ◽

Spinal Cord Tumor ◽

Tumor Resection ◽

Ease Of Use ◽

Dermal Sinus ◽

Flexible Fiber ◽

First Case ◽

Surgical Tool

Object The authors report their experience with a novel flexible fiber capable of transmitting CO2 laser energy during spinal cord tumor resection and detethering. Methods A fiber optic system capable of transmitting CO2 laser energy was used in the detethering of the spinal cord in 3 cases. The first case involved a 9-year-old girl with a terminal lipoma. The second case was an 11-month-old boy with a thoracic intramedullary dermoid and dermal sinus tract. The third case involved a 13-year-old girl suffering from a tethered spinal cord subsequent to a previously repaired myelomeningocele. Results In all 3 cases, the new fiber CO2 laser technology allowed the surgeon to perform microsurgical dissection while sparing adjacent neurovascular structures without time-consuming setup. The system was easy to implement, more ergonomic than previous technologies, and safe. The CO2 laser provided the ability to cut and coagulate while sparing adjacent tissue because of minimal energy dispersion and ease of use, without the articulating arms involved in the prior generation of lasers. Conclusions Using a flexible fiber to conduct CO2 laser energy allows accurate microneurosurgical dissection and renders this instrument a high-precision and ergonomic surgical tool in the setting of spinal cord detethering.

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Resection of Ventral Thoracic Calcified Meningiomas Through a Transpedicular Approach: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa378 ◽

2020 ◽

Author(s):

Michael A Galgano ◽

Haydn Hoffman

Keyword(s):

Spinal Cord ◽

Posterior Instrumentation ◽

Video Recording ◽

Tumor Resection ◽

Thoracic Spinal Cord ◽

Lower Extremity Weakness ◽

Transpedicular Approach ◽

Institutional Review ◽

Thoracic Spinal ◽

Microsurgical Resection

Abstract The surgical resection of ventrally located thoracic lesions carries additional complexity because of the constraints of the mediastinum and pleural cavity as well as the intolerance of the spinal cord to manipulation. The creation of a ventrolateral operative corridor through a transpedicular, transarticular route is effective for accessing the ventral thoracic spinal cord. This operative video demonstrates the surgical management of a 67-yr-old female who presented with progressive gait ataxia and bilateral lower extremity weakness and was found to have noncontiguous calcified ventral thoracic meningiomas at T6 and T10. The surgical plan consisted of T4-11 posterior instrumentation, T5-6 and T9-10 laminectomies with unilateral facetectomies and pediculectomies at both segments, and microsurgical resection of both tumors. Postoperatively, the patient's gait and paraparesis improved. Although instrumentation is infrequently utilized when managing intradural pathology, it permitted aggressive bone removal in order to create an unobstructed ventrolateral corridor to the tumor. This allowed us to perform generous durotomies spanning the length of each lesion and obviated the need for spinal cord manipulation during tumor resection. The patient provided informed consent for the surgery and video recording, and institutional review board approval was determined to be unnecessary.

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Hypogastric Artery Stenting for Chronic Intermittent Spinal Cord Ischemia After Thoracic Endovascular Aortic Repair

Journal of Endovascular Therapy ◽

10.1177/1526602820925445 ◽

2020 ◽

Vol 27 (5) ◽

pp. 801-804

Author(s):

Catharina Gronert ◽

Nikolaos Tsilimparis ◽

Giuseppe Panuccio ◽

Ahmed Eleshra ◽

Fiona Rohlffs ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Ischemia ◽

Thoracic Endovascular Aortic Repair ◽

Neurological Symptoms ◽

Endovascular Aortic Repair ◽

Hypogastric Artery ◽

Lower Extremity Weakness ◽

Aortic Repair ◽

The Right

Purpose: To report a case of chronic intermittent spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) and its successful treatment using hypogastric artery stenting. Case Report: A 79-year-old patient presented in May 2013 with a thoracic aortic aneurysm (TAA) and a contained rupture. He urgently underwent TEVAR that covered 274 mm of descending thoracic aorta without immediate postoperative signs of acute SCI. At 3-month follow-up, he reported repeating incidents of sudden lower extremity weakness leading to a fall with a humerus fracture. A neurological consultation revealed the tentative diagnosis of intermittent SCI caused by TEVAR and initially recommended a conservative approach. During the following year there was no clinical improvement of the symptoms. Computed tomography angiography showed a high-grade stenosis of the right hypogastric artery, which was stented in November 2014 to improve the collateral network of spinal cord perfusion. Following treatment, the patient had no further neurological symptoms; at 32 months after the reintervention, the imaging follow-up documented a patent stent and continued exclusion of the TAA. Conclusion: Intermittent neurological symptoms after TEVAR should be suspected as chronic intermittent SCI. The improvement of collateral networks of the spinal cord by revascularization of the hypogastric artery is a viable treatment option.

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Autonomic dysreflexia associated with cervical spinal cord gliofibroma: case report

BMC Neurology ◽

10.1186/s12883-021-02271-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hiroyuki Mizuno ◽

Fumiaki Honda ◽

Hayato Ikota ◽

Yuhei Yoshimoto

Keyword(s):

Spinal Cord ◽

Cervical Spinal Cord ◽

Spinal Cord Tumor ◽

Autonomic Dysreflexia ◽

Tumor Biopsy ◽

Intramedullary Lesion ◽

First Case ◽

Cord Injury ◽

Paroxysmal Hypertension ◽

Upper And Lower Extremities

Abstract Background Autonomic dysreflexia (AD) is an abnormal reflex of the autonomic nervous system normally observed in patients with spinal cord injury from the sixth thoracic vertebra and above. AD causes various symptoms including paroxysmal hypertension due to stimulus. Here, we report a case of recurrent AD associated with cervical spinal cord tumor. Case presentation The patient was a 57-year-old man. Magnetic resonance imaging revealed an intramedullary lesion in the C2, C6, and high Th12 levels. During the course of treatment, sudden loss of consciousness occurred together with abnormal paroxysmal hypertension, marked facial sweating, left upward conjugate gaze deviation, ankylosis of both upper and lower extremities, and mydriasis. Seizures repeatedly occurred, with symptoms disappearing after approximately 30 min. AD associated with cervical spinal cord tumor was diagnosed. Histological examination by tumor biopsy confirmed the diagnosis of gliofibroma. Radiotherapy was performed targeting the entire brain and spinal cord. The patient died approximately 3 months after treatment was started. Conclusions AD is rarely associated with spinal cord tumor, and this is the first case associated with cervical spinal cord gliofibroma. AD is important to recognize, since immediate and appropriate response is required.

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Intraoperative 3T MR Imaging for Spinal Cord Tumor Resection: Feasibility, Timing, and Image Quality Using a “Twin” MR–Operating Room Suite

American Journal of Neuroradiology ◽

10.3174/ajnr.a1134 ◽

2008 ◽

Vol 29 (10) ◽

pp. 1991-1994 ◽

Cited By ~ 6

Author(s):

T.P. Duprez ◽

A. Jankovski ◽

C. Grandin ◽

L. Hermoye ◽

G. Cosnard ◽

...

Keyword(s):

Spinal Cord ◽

Image Quality ◽

Mr Imaging ◽

Operating Room ◽

Spinal Cord Tumor ◽

Tumor Resection ◽

3T Mr

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Resection of 2 Intradural Extramedullary Cervical Spine Tumors in a Patient With Neurofibromatosis Type 2: 3-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy149 ◽

2018 ◽

Vol 16 (2) ◽

pp. 274-274

Author(s):

Simone E Dekker ◽

Chad A Glenn ◽

Thomas A Ostergard ◽

Osmond C Wu ◽

Fernando Alonso ◽

...

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Treatment Options ◽

Tumor Resection ◽

Neurofibromatosis Type ◽

Cord Compression ◽

Neurofibromatosis Type 2 ◽

3 Dimensional ◽

Intradural Extramedullary

Abstract This 3-dimensional operative video illustrates resection of 2 cervical spine schwannomas in a 19-yr-old female with neurofibromatosis type 2. The patient presented with lower extremity hyperreflexity and hypertonicity. Magnetic resonance imaging (MRI) demonstrated 2 contrast-enhancing intradural extramedullary cervical spine lesions causing spinal cord compression at C4 and C5. The patient underwent a posterior cervical laminoplasty with a midline dural opening for tumor resection. Curvilinear spine cord compression is demonstrated in the operative video. After meticulous dissection, the tumors were resected without complication. The dural closure was performed in watertight fashion followed by laminoplasty using osteoplastic titanium miniplates and screws. Postoperative MRI demonstrated gross total resection with excellent decompression of the spinal cord. The postoperative course was uneventful. The natural history of this disease, treatment options, and potential complications are discussed.

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