Multidisciplinary management of invasive vertebral hemangioma: the role of different neurointervention modalities—a retrospective study

IF 0.7 Q4 CLINICAL NEUROLOGY Egyptian journal of neurosurgery Pub Date : 2023-09-11 DOI:10.1186/s41984-023-00218-9
Ahmed Elsayed Sultan, Tamer Hassan, Mohamed Abdelbary, Amr Elwany
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Abstract

Abstract Background Catastrophic intraoperative bleeding is a major complication of surgical removal of invasive vertebral hemangioma. Interventional neuroradiology techniques could be more useful tools to manage such hemorrhagic lesions. Results Retrospective analysis of cases of invasive vertebral hemangioma revealed 17 cases treated at the Alexandria University School of Medicine from 2006 to 2020. The study included 52.9% of males with a mean age of 38.4 ± 18.6 years old. All patients reported local and sometimes radicular pain; 64.7% exhibited progressive neurological deficits. Imaging revealed thoracic spine affection in 11 cases, lumbar vertebral in four cases, and cervical vertebra in two cases. Vertebral involvement occurred in 10 cases and paravertebral extension in 13 cases. Neurointervention modalities included transarterial embolization followed by corpectomy and fixation (one case with C4 lesion), direct surgery with corpectomy and anterior fixation (one case with C7 lesion), vertebroplasty alone (four cases), vertebroplasty with fixation (seven cases), and direct transpedicular alcohol injection with immediate devascularization and necrosis of the vascular channels inside the lesions (six cases). The alcohol injection use ranged from 4 to 10 ml in each pedicle. All patients did well during the follow-period post-intervention. The neurological deficits improved over six months. All patients showed improved Nurick grade regardless of the intervention (preoperative mean 2.7 ± 1.9 vs. postoperative mean 1.1 ± 1.3, p value 0.0001). Two patients were completely paraplegic, but with intact deep sensation, they improved dramatically and can walk unsupported post-intervention. Conclusions Vertebral hemangioma can present in an invasive manner that necessitates intervention. Preoperative embolization, alcohol injection, or vertebroplasty are helpful methods to decrease intraoperative catastrophic hemorrhage. Alcohol injection is cost-effective with immediate devascularization of the lesion. The extensive 360 surgery utilization can be decreased with the use of alcohol and vertebroplasty. More cases are needed to validate these conclusions.
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侵袭性椎体血管瘤的多学科治疗:不同神经干预方式的作用-一项回顾性研究
背景:术中大出血是侵袭性椎体血管瘤手术切除的主要并发症。介入神经放射学技术可能是治疗此类出血性病变的更有用的工具。结果回顾性分析亚历山大大学医学院2006 - 2020年收治的17例侵袭性椎体血管瘤病例。男性占52.9%,平均年龄38.4±18.6岁。所有患者均报告局部疼痛,有时伴有神经根性疼痛;64.7%表现为进行性神经功能缺损。影像学显示胸椎病变11例,腰椎病变4例,颈椎病变2例。椎体受累10例,椎旁伸展13例。神经干预方式包括经动脉栓塞后椎体切除和固定(1例C4病变),直接手术椎体切除和前路固定(1例C7病变),单独椎体成形术(4例),椎体成形术合并固定(7例),直接经椎弓根酒精注射立即断流和病变内血管坏死(6例)。每个椎弓根的酒精注射用量为4至10毫升。所有患者在干预后的随访期间均表现良好。六个月后,神经功能的缺陷得到了改善。无论干预与否,所有患者的Nurick评分均有改善(术前平均2.7±1.9,术后平均1.1±1.3,p值0.0001)。两名患者完全截瘫,但深层感觉完好,他们在干预后显著改善,可以在没有支持的情况下行走。结论椎体血管瘤可表现为侵袭性,需要介入治疗。术前栓塞、酒精注射或椎体成形术是减少术中大出血的有效方法。酒精注射对于立即断流病变是经济有效的。使用酒精和椎体成形术可以减少广泛的360度手术的使用。需要更多的案例来验证这些结论。
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