2009, Number 2
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Cir Cir 2009; 77 (2)
Vertebral hemangioma of the posterior arch with subsequent extraosseous extension and neurological symptoms. Case report and literature review
Alpízar-Aguirre A, Zárate-Kalfópulos B, Rosales-Olivares LM, Baena-Ocampo LC, Reyes-Sánchez AA
Language: Spanish
References: 28
Page: 127-130
PDF size: 146.46 Kb.
ABSTRACT
Background: Vertebral hemangioma is the most common benign spinal tumor and is found in 11% of postmortem studies as a slow-growing benign vascular malformation. It usually involves the vertebral body and sometimes the posterior vertebral elements. When the posterior elements are involved, spinal cord compression with neurological symptoms are seen more often. Vertebral hemangiomas exist as a continuum of manifestations and lesions ranging from the common asymptomatic forms to the rare compression lesion. Extraosseous extension of vertebral hemangioma with cord compression and neurological symptoms is a rare condition and represents a treatment challenge. Surgical options are open resection, embolization or vertebroplasty.
Clinical case: We report a case of a vertebral hemangioma with extraosseous extension to the spinal canal with an unusual size and osseous component in the posterior elements. This tumor caused neurological manifestations and was surgically treated with posterior decompression and stabilization with transpedicular screws and rods. Clinical outcome was good.
Conclusions: Vertebral hemangioma is normally an asymptomatic benign lesion not requiring specific treatment. Only in a few cases is surgical treatment required. When neurological compromise is present, early treatment should be carried out before the presence of permanent paralysis.
REFERENCES
Schnyder P, Fankhauser H, Mansouri B, Computed tomography in spinal hemangioma with cord compression. Skeletal Radiol 1986;15:372-377.
Greenler DP, Klein HA. The scope of false-positive iodine-131 images for thyroid carcinoma. Clin Nucl Med 1989;14:111-113.
Bakheet ASM, Hammami MM. False positive radioiodine whole body scan in thyroid cancer patients due to unrelated pathology. Clin Nucl Med 1994;19:325-327.
Lee S, Hadlow A. Extraosseous extension of vertebral hemangioma, a rare cause of spinal cord compression. Spine 1999;24:2111-2114.
Laredo JD, Reizine D, Bard M, Merland J. Vertebral hemangiomas: radiologic evaluation. Radiology 1986;161:183-189.
Tekkok IH, Acikgoz B, Saglam S, Onol B. Vertebral hemangioma symptomatic during pregnancy—report of a case and review of the literature. Neurosurgery 1993;32:302-306.
Pastushyn A, Slinko E, Mirzoyeva G. Vertebral hemangiomas: diagnosis, management. Natural history and clinicopathological correlation in 86 patients. Surg Neurol 1998;50:535-547.
Fujimoto H, Ueda T, Masuda S, Nosaka K. Blood-pool scintigraphic diagnosis of fractured lumbar vertebral hemangioma. Skeletal Radiol 2001;30:223-225.
Puvaneswary M, Cuganesan R, Barbarawi M, Spittaler P. Vertebral haemangioma causing cord compression: MRI finding. Australas Radiol 2003;47:190-193.
Lee JW, Cho EY, Hong SH, Chung HW, Kim JH, Chang KH. Spinal epidural hemangiomas: various types of MRI imaging features with histopathologic correlation. AJNR Am J Neuroradiol 2007;28:1242-1248.
Fox MW, Onofrio BM. The natural history and management of symptomatic and asymptomatic vertebral hemangiomas. J Neurosurg 1993;78:36-45.
Laredo J, Assouline E, Gelbert F, Wybier M, Merland J, Tubiana J. Vertebral hemangiomas: fat content as a sign of aggressiveness. Radiology 1990;177:467-472.
Perman E. On hemangioma in the spinal column. Acta Chir Scand 1926;61:91-105.
McAllister AL, Kendall BE, Bull JWD. Symptomatic vertebral hemangiomas. Brain 1975;98:71-80.
Korres DS, Karachalios T, Roidis N, Bargiotas K, Stamos K. Pain pattern in multiple vertebral hemangioma involving non-adjacent levels: reports of two cases. Eur Spine J 2000;9:56-60.
Gabal A. Percutaneous technique for sclerotherapy of vertebral hemangioma compressing spinal cord. Cardiovasc Intervent Radiol 2002;25:494-500.
Cotten A, Deramond H, Cortet B, Lejeune JP, Leclerc X, Chastanet P. Preoperative percutaneous injection of methyl methacrylate and N-butyl cyanoacrylate in vertebral hemangiomas. Am J Neuroradiol 1996;17:137-142.
Laguna R, Silva F, Vázquez-Selles J, Orduna E, Flores C. Vertebral hemangioma mimicking a metastatic bone lesion in well-differentiated thyroid carcinoma. Clin Nucl Med 2000;25:611-613.
Bas T, Aparisi F, Bas J. Efficacy and safety of ethanol injections in 18 cases of vertebral hemangioma. Spine 2001;26:1577-1582.
Niemeyer T, McClellan J, Webb J, Jaspan T, Ramli N. Brown-Sequard syndrome after management of vertebral hemangioma with intralesional alcohol injection. Spine 1999;24:1845-1847.
Smith TP, Koci T, Mehringer CM. Transarterial embolization of vertebral hemangioma. J Vasc Interv Radiol 1993;4:681-685.
Cotten A, Boutry N, Cortet B, Assaker R. Demondion X, Leblond D, et al. Percutaneous vertebroplasty: state of the art. Radiographics 1998;18:311-320.
Deramond H, Damasson R, Galibert P. Percutaneous vertebroplasty with acrylic cement in the treatment of aggressive spinal angiomas. Rachis 1989;1:143-153.
Galibert P, Deramond H. Percutaneous acrylic vertebroplasty as a treatment of vertebral angioma as well as painful and debilitating diseases. Chirurgie 1990;116:326-334.
Heiss J, Doppman JL, Oldfield EN. Brief report: relief of spinal cord compression from vertebral hemangioma by intralesional injection of absolute ethanol. N Engl J Med 1994;25:508-511.
Ide C. Gangi A, Rimelin A, Beaujeux R, Maitrot D, Buchheit F. Vertebral hemangiomas with spinal cord compression: the place of preoperative percutaneous vertebroplasty with methyl methacrylate. Neuroradiology 1996;38:585-589.
Guedea F, Majo J, Guardia E, Canals E, Craven-Bartle J. The role of radiation therapy in vertebral hemangiomas without neurologic signs. Int Orthop 1994;118:77-79.
Asthana AK, Tandon SC, Pant GC, Srivastava A, Pradhan S. Radiation therapy for symptomatic vertebral hemangioma. Clin Oncol 1990;2:159-162.