Hrabálek L., Starý M., Rosík S., Wanek T.: Surgery for Symptomatic Vertebral Hemangiomas

Česká verzia

Authors: L. Hrabálek; M. Starý ^*; S. Rosík ^*; T. Wanek
Authors place of work: Neurochirurgická klinika FN a LF UP Olomouc, přednosta: prof. MUDr. M. Houdek, CSc. ; Neurochirurgické oddělení nemocnice Ostrava-Fifejdy, primář: MUDr. M. Starý ^*
Published in the journal: Rozhl. Chir., 2011, roč. 90, č. 5, s. 264-269.
Category: Monothematic special - Original

Summary

Introduction and Aim:
Vertebral hemangiomas (VH) are usually asymptomatic and, therefore, are commonly detected as accidental findings on spinal imaging. No treatment is indicated in these cases. Nevertheless, some hemangiomas may clinically manifest as axial pain and neurological deficit and may require surgery or other treatment. The aim of this study was to assess outcomes of surgical management of symptomatic vertebral hemangiomas at two neurosurgical clinics.

Material and Methods:
Prospective study of patients with symtomatic vertebral hemangioma managed surgically at Neurosurgical Clinic of Faculty Hospital and Medical Faculty (FN and LF UP) of Palacky University in Olomouc and at Neurosurgical Department of Ostrava-Fifejdy Hospital. Surgery was indicated in patients with confirmed thoracic and lumbar vertebral hemangioma, presenting with axial, eventually with radicular pain and /or neurological deficit, such as myelopathy or radicular lesion. In cases where the only basis for indication for surgery was axial lumbar pain, the procedure included only vertebroplasty (VP) of the vertebral body (Vertecem, Synthes, USA). In cases with neurological dysfunction, posterior decompression using hemilaminectomy with extirpation of hemangioma tissue protruding into the spinal canal, as well as vertebroplasty, was indicated. During the 13-month study period, 7 patients aged from 38 to 80 years (the mean age of 60.3 years) were operated. The subjects included 4 males and 3 females.

Follow up examinations were performed during hospitalization, at 6 weeks and at 6 months after the procedure. On the last follow up examination, the patients were asked to assess axial and radicular pain based on the VAS scale, ODI and the surgeons evaluated the degree of myelopathy according to Frankel and JOA classification.

Results:
Vertebroplasty had positive impact on the degree of axial and radicular pain in all subjects (seven patients) and combination of VP with decompression resulted in improvement of myelopathic symptoms in all the subjects concerned (three patients).

No spinal canal cement leak or embolization during VP was recorded, neither surgical wound healing complications, such as hematoma or infection, were recorded. No surgical revisions were required.

Discussion:
The aim of symptomatic vertebral hemangioma therapy include nervous tissue decompression, spinal stabilization and prevention of spontaneous or traumatic epidural bleeding. Nervous tissue decompression using laminectomy or hemilaminectomy can be indicated only in patients developing severe paraparesis and may have good outcome. It is advisable to combine decompression with vertebroplasty or balloon kyphoplasty, arterial embolization or intralesional alcohol injection.

Conclusion:
Vertebroplasty resulted in pain score improvement in all patients with symptomatic vertebral hemangiomas. Combinations of vertebroplasty and decompression had positive impact on myelopathic symptoms in all the patients concerned.

Key words:
vertebral hemangioma – vertebroplasty – spinal surgery

Zdroje

1. Ahn, H., Jhaveri, S., Yee, A., Finkelstein, J. Lumbar vertebral hemangioma causing cauda equina syndrome: a case report. Spine, 2005; 30: E662–E664.

2. Hrabálek, L. Komplexní léčba symptomatických obratlových hemangiomů. Acta Chir. orthop. Traum. čech., 2010; 77: 149–153.

3. Adamus, M., Herold, I., Trenkler, Š., Koutná, J., Kropáč, A., Závada, J. Klasifikace fyzického stavu nemocného podle ASA – dozrál čas na změnu? Anest. intenziv. Med., 2007; 18: 9–23.

4. Deb, H. K., Datta, N. Vertebral hemangioma causing cord compression and paraplegia. J. Ind. Med. Assoc., 1982; 79: 58–59.

5. Nguyen, J. P., Djindjian, M., Gaston, A., Gherardi, R., Benhaiem, N., Caron, J. P., Poirier, J. Vertebral hemangiomas presenting with neurologic symptoms. Surg. Neurol., 1987; 27: 391–397.

6. Hemmy, D. C. Neurosurgery. Vertebral Hemangiomas. 2nd ed. McGraw-Hill, 1996: 1827–1929.

7. Schajowitz, F., Ackerman, L. V., Sisson, H. A. Histological Typing of Bone Tumors. Geneva: World Health Organization, 1972.

8. Goyal, A., Singh, A. K., Gupta, V., Tatke, M. Spinal epidural hemangioma: a case report and review of literature. Spinal Cord., 2002; 40: 200–202.

9. Laredo, J. D., Assouline, E., Gelbert, F., Wybier, M., Merland, J. J., Tubiana, J. M. Vertebral hemangiomas: fat content as a sign of agressiveness. Radiology, 1990; 177: 467–472.

10. Nader, R., Alford, B. T., Nauta, H. J., Crow, W., Vansonnengerg, E., Hadjepavlou, A. G. Preoperative embolization and intraoperative cryocoagulation as adjuncts in resection of hypervascular lesions of the thoracolumbar spine. J. Neurosurg., 2002; 97(suppl 3): 294–300.

11. Rudnick, J., Stern, M. Symptomatic thoracic vertebral hemangioma: a case report and literature review. Arch. Phys. Med. Rehabil., 2004; 85: 1544–1547.

12. Hekster, R. E. M., Luyendijk, W., Tan, T. I.: Spinal cord compression caused by vertebral hemangioma relieved by percutaneous catheter embolisation. Neuroradiology, 1972; 3: 160–164.

13. Heiss, J. D., Doppman, J. L., Oldfield, E. H. Brief report: relief of spinal cord compression from vertebral hemangioma by intralesional injection of absolute alkohol. N. Engl. Med., 1994; 53 (suppl 2): 42–43.

14. Eisenstein, S., Spiro, F., Browde, S., Allen, C. M., Grobler, L. The treatment of a symptomatic vertebral hemangioma by radiotherapy. Spine, 1986; 11: 640–642.

15. Deramond, H., Depriester, C., Galibert, P., Le Gars, D. Percutaneous vertebroplasty with polymethylmetacrylate: technique, indications, and results. Radiol. Clin. North Am., 1998; 36: 533–546.

16. Atalay, B., Caner, H., Yilmaz, C., Altinors, N. Sacral kyphoplasty for relieving pain cause by sacral hemangioma. Spinal Cord., 2006; 44: 196–199.

17. Scott, D. L., Pedlow, F. X., Hecht, A. C., Hornicek, F. J. Primary Benign and Malignant Extradural Spine Tumors. 3rd ed. Philadelphia, Lippincott Williams and Wilkins, 2004: 207–210.

18. Heyd, R., Strassmann, G., Filipowitz, I., Borowsky, K., Martin, K., Zamboglou, N. Radiotherapy in vertebral hemangioma. Roentgenpraxis, 2001; 53: 208–220.

19. Acosta, F. L. Jr., Dowd, C. F., Chin, C., Tihan, T., Ames, C. P., Weinstein, P. R. Current treatment strategie and outcomes in the management of symptomatic vertebral hemangiomas. Neurosurgery, 2006; 58: 287–295.

20. Goyal, M., Mishra, N. K., Sharma, A., Gaikwad, S. B., Mohanty, B. K., Sharma, S. Alcohol ablation of symptomatic vertebral hemangiomas. AJNR Am. J. Neuroradiol., 1999; 20: 1091–1096.

21. Cohen, J. E., Lylyk, P., Ceratto, R., Kaplan, L., Umanskyt, F., Gomori, J. M. Percutaneous vertebroplasty: technique and results in 192 procedures. Neurol. Res., 2004; 26: 41–49.

22. Galibert, P., Deramond, H., Rosat, P., Le Gars, D. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie, 1987; 33: 166–168.

23. Muto, M., Muto, E., Izzo, R., Diano, A. A., Lavanga, A., Di Furia, U. Vertebroplasty in the treatment of back pain. Radiol. Med. (Torino), 2005; 109: 208–219.

24. Včelák, J., Tóth, L., Šlégl, M., Šuman, R., Majerníček, M. Vertebroplastika a kyfoplastika – metoda léčby osteoporotických zlomenin páteře. Acta Chir. orthop. Traum. čech., 2009; 76: 54–59.

25. Brunot, S., Berge, J., Barreau, X., Menegon, P., Dousset, V. Long term clinical follow up of vertebral hemangiomas treated by percutaneous vertebroplasty. J. Radiol., 2005; 86: 41–47.

26. Evangelopoulos, D. S., Kontovazenitis, P., Kokkinis, K., Glynos, M., Korres, D. S., Sapkas, G. Cement leakage in a symptomatic vertebral hemangioma: a case report and review of the literature. Cases Journal, 2009; 2: 7148.