Management of Aggressive Vertebral Hemangiomas Presenting with Spinal Cord Compression
Thanapol Ngammanee MD*,**, Akkapong Nitising MD*, Bunpot Sitthinamsuwan MD*, Luckchai Phonwijit MD*
Affiliation : * Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand * Department of Surgery, Buriram Hospital, Buriram, Thailand
Background : Vertebral hemangioma (VH) is the most common benign vertebral tumor. Most patients are asymptomatic.
Neurological deficit due to spinal cord compression is a rare presentation of symptomatic VH.
Objective : This study aims to describe patients who developed compressive myelopathy owing to aggressive VH and were
treated by surgical decompression.
Material and Method: Retrospective chart reviews of patients with symptomatic VH manifesting by compressive myelopathy
were conducted. Spinal radiograph, magnetic resonance imaging (MRI) and angiography were collected.
Results : Three cases with spinal cord compression caused by VH were included in the study. VH was suspected by preoperative
spinal MRI in only one case. Preoperative embolization was performed for reducing intraoperative blood loss. The remaining
two did not undergo embolization before surgery. Significant blood loss during the operation made the surgeon terminate the
procedure. The second-stage procedure was performed following embolization. The intraoperative blood loss was minimized.
Conclusion : VH is a differential diagnosis in patients with spinal tumor presenting with pain and myelopathy. Massive
bleeding from the tumor during surgical decompression can be reduced by transarterial embolization. Multidisciplinary
treatment is the mainstay in management of VH.
Keywords : Vertebral hemangioma, Spinal cord compression, Surgical decompression
