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

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.

Vertebral Body Infarction after Transarterial Preoperative Embolization of a Vertebral Hemangioma

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.

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

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

Recurrent symptomatic vertebral hemangioma in pregnancy managed with decompression and vertebroplasty

Background: Vertebral hemangioma is a benign vascular tumor of the spine that occurs in the endothelial lining of blood vessels. The majority of these lesions are detected incidentally on routine magnetic resonance imaging scans. Rarely, lesions can increase in size and result in neurological deterioration. Case Description: A 19-year-old post-partum female, presented with paraplegia due to a recurrent vertebral hemangioma with exophytic extension into the epidural space resulting in spinal cord compression. Early decompressive surgery facilitated adequate early recovery of neurological function. Conclusion: Exophytic vertebral hemangiomas that have extended into the spinal canal resulting in cord compression require urgent surgical decompression.

Radiotherapy efficacies for vertebral hemangioma patients with severe spinal cord compression and cauda equina syndrome

Background: Although vertebral hemangioma is the most common benign spine tumor, rare patients may experience spinal cord compression accompanied by pain and neurological deficits, in whom surgery remains the standard treatment option. For patients with comorbidities who cannot tolerate operation, radiotherapy may be an alternative treatment, however, previous studies suggested that if spinal cord cannel was aggressively compressed by vertebral hemangioma, the efficacies of radiotherapy were suboptimal. Methods and results: Herein, we presented two patients with vertebral hemangioma who developed spinal cord compression, first patient with underlying congenital heart disease had spinal canal encroachment of 63.4% at ninth thoracic vertebra, and second patient failed to transcatheter arterial embolization for treating total encroachment of sacrum plexus. The first patient underwent radiotherapy with 44 Gy at 20 fractions using Tomotherapy and became fully recovered from the severe neurological deficits at 5.5 months after completing radiotherapy. The second patient benefited from neurological symptoms relief at 6 months after completion of radiotherapy using 42 Gy at 21 fractions using volumetric modulated arc therapy (VMAT) technique.Conclusions: Our results indicate that radiotherapy with 42 to 44 Gy using conventional fractions could efficiently cause tumor regressions and improve neurological symptoms resulted from vertebral hemangioma-causing spinal cord compression.