Combined surgical and endovascular approach for treatment of aggressive vertebral haemangiomas

Abstract

Objective: To analyze the endovascular, surgical, and clinical outcomes of patients with aggressive vertebral haemangiomas (VHs) treated over a 17 year period.

Methods: All medical, radiological, and surgical records were reviewed retrospectively. All patients underwent follow-up evaluation for pain and neurological outcome.

Results: A total of 10 patients diagnosed with aggressive VHs causing neurologic compromise or pain underwent 13 operative procedures for tumour resection/stabilization. All but one patient underwent preoperative procedures to minimize intraoperative blood loss. Mean follow-up length was 26.3 months. Of eight patients presenting with neurological deficits, all improved postoperatively. The two patients presenting with pain reported improvement postoperatively. Two patients had new postoperative lower extremity weakness, both of which improved during follow-up. One patient experienced tumour recurrence at 1 year, requiring a second staged surgery. A second patient required a staged surgery for resection of multiple VHs. Seven patients had subtotal resections, two patients had gross total resections, and one patient had an en bloc resection of tumour.

Conclusions: Combined preoperative embolization followed by aggressive tumour resection and spinal stabilization are safe and effective procedures for the treatment of aggressive VH causing symptomatic stenosis.

Keywords:

• Vertebral haemangioma
• embolisation
• surgery
• spine
• neoplasm
• fusion

Acknowledgments

The authors would like to acknowledge Dr. Karthik Madhavan for reviewing the angiography images, and Linda Alberga for editorial assistance.

Disclosure statement

Dr. Allan D. Levi receives teaching honoraria from the American Association of Neurosurgeons (AANS) and grant support from the Department of Defense.