File Name: the natural history and management of symptomatic and asymptomatic vertebral hemangiomas .zip
Corresponding author: Devanand Degulmadi. This article presents a year-old obese female who presented with back pain and progressive weakness in her lower limbs for three months. She was bed-ridden for one week before reporting to our hospital. Plain radiographs showed vertical striations in multiple vertebrae classical of haemangioma. Magnetic resonance imaging MRI spine revealed multiple thoracic and lumbar vertebral haemangiomas. Extra osseous extension of haemangioma at T12 was causing spinal cord compression.
Histologically VHs are not considered vascular neoplasms, but rather hamartomas or malformation of the microcirculation. Basing on the predominant type of vascular channel they are classified in: capillary, cavernous, arterio-venous and venous malformations. Most of spinal epidural hemangiomas belongs to the cavernous type 1. Numerous terms have been introduced and different classification systems. Unfortunately, none of these has been accepted due to the lack of accepted histological criteria and limited correlation with clinical outcome. Vascular tumours of bone originate from endothelial cells resulting in variable expression of endothelial markers, but none of these markers is useful to discriminate between benign and malignant lesions.
Vertebral hemangiomas were discovered incidentally in 35 patients, while pain was the presenting complaint in 13 patients. Five patients presented directly with progressive neurological deficit requiring surgery, and six patients had surgery elsewhere for spinal cord compression and were referred for follow-up evaluation. To better define the natural history of these lesions, a historical review of these patients was conducted; progression of an asymptomatic or painful lesion to neurological symptoms was found in only two cases mean follow-up period 7. New-onset back pain followed by subacute progression mean time to progression 4. Initially, all 11 patients with spinal cord compression underwent decompressive surgery with full neurological recovery. Recurrent neurological symptoms were observed in three of six patients following subtotal tumor resection and postoperative administration of cGy or less radiation therapy mean follow-up period 8. No recurrences were noted in four patients who had subtotal excision plus radiotherapy between and cGy.
Rarely, altered hemodynamic and hormonal changes during pregnancy may expand these benign lesions resulting in severe cord compression. The management of symptomatic vertebral hemangioma during pregnancy is controversial as modalities like radiotherapy and embolization are not suitable and surgery during pregnancy has a risk of preterm labor. Few cases of pregnancy related symptomatic vertebral hemangioma with marked epidural component have been reported in the literature. We report a case of year-old primigravida who developed rapidly progressive paraparesis at 28 weeks of gestation and spine magnetic resonance imaging MRI revealed upper thoracic vertebral hemangioma with extensive extra-osseous extension and spinal cord compression. Laminectomy and surgical decompression of the cord was performed at 32 weeks of the pregnancy. There was significant improvement in muscle power after a week of surgery. Six weeks postoperatively she delivered a full term normal baby with subsequent improvement of neurologic deficit.
Spinal tumors are rare in the pediatric population, presenting many specific peculiarities when compared to adults. We have performed a broad narrative review to describe the most common spinal tumors in children, discussing their main characteristics and management options. The authors have performed an extensive review of the peer-reviewed literature addressing the aforementioned objectives. Multimodality radiological studies plain films, 3D computed tomography scan and magnetic resonance imaging are necessary for proper evaluation and differential diagnosis of spinal tumors in children. In selected cases nuclear medicine imaging is used to improve the chances of a more accurate diagnosis.
Two patients developed spinal cord compression from previously diagnosed vertebral hemangiomas. One of these patients had a known asymptomatic lesion.
Vertebral hemangiomas are common benign vascular tumors of the spine. It is very rare for these lesions to symptomatically compress neural elements. If spinal cord compression does occur, it usually involves only a single level.
Kevin A. Moattari, Rojeh Melikian, Sanjay K. They are asymptomatic, incidental findings in the vast majority of patients; however, in rare cases, they can expand to cause neural compression.