Aggressive vertebral hemangioma of the thoracic spine without typical radiological appearance

Purpose Vertebral hemangioma (VH) is virtually vascular malformation, which is usually asymptomatic. Only 3.7 % of VH may become active and symptomatic, and 1 % may invade the spinal canal and/or paravertebral space. Treatment protocols for active or aggressive VHs are still in controversy. Reported...

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Bibliographic Details
Published in:European spine journal 2012-10, Vol.21 (10), p.1994-1999
Main Authors: Dang, Lei, Liu, Chen, Yang, Shao Min, Jiang, Liang, Liu, Zhong Jun, Liu, Xiao Guang, Yuan, Hui Shu, Wei, Feng, Yu, Miao
Format: Article
Language:English
Subjects:
Adult
alcohols
Algorithms
Biopsy
Bone surgery
Canals
Decompression
Embolization
Female
Grand Rounds
hemangioma
Humans
Medicine
Medicine & Public Health
Neurosurgery
Osteolysis
Pain
Radiography
Radiotherapy
Radiotherapy, Adjuvant
Skull - abnormalities
Skull - diagnostic imaging
Skull - surgery
Spinal Fusion
Spine
Spine - abnormalities
Spine - diagnostic imaging
Spine - surgery
Surgery
Surgical Orthopedics
Vascular Malformations - diagnostic imaging
Vascular Malformations - radiotherapy
Vascular Malformations - surgery
Vertebrae
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Summary:Purpose Vertebral hemangioma (VH) is virtually vascular malformation, which is usually asymptomatic. Only 3.7 % of VH may become active and symptomatic, and 1 % may invade the spinal canal and/or paravertebral space. Treatment protocols for active or aggressive VHs are still in controversy. Reported treatments include radiotherapy, vertebroplasty, direct alcohol injection, embolization, surgery and a combination of these modalities. Methods A 41-year-old lady was presented with 18 month history of intermittent back pain. CT revealed T5 osteolytic lesion with epidural and paravertebral extension. The first CT guided biopsy yielded little information. Results Histopathological diagnosis of the second biopsy was VH. Vertebroplasty, posterior decompression and fixation were performed followed by postoperative radiotherapy. Her symptoms were resolved immediately after the operation. At 12 months follow-up, no recurrence was detected by CT with contrast enhancement. Conclusion Surgical decompression, vertebroplasty and fixation are safe and effective for aggressive VH. More attention is needed in determining the algorithm for the diagnosis and treatment of aggressive VH.
ISSN:0940-6719
1432-0932
DOI:10.1007/s00586-012-2349-1