Surgical strategies in the management of aggressive spinal haemangiomas: Retrospective case series with literature review and a practical treatment algorithm
Purpose: We studied the clinico-radiological features and treatment outcomes of patients with aggressive spinal haemangiomas. Methods: We undertook a retrospective review of 24 patients with aggressive spinal haemangiomas managed at our centre from 2004 to 2016. The cohort was divided into two group...
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Elsevier
2024-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S277252942301024X |
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| author | Ganesh Swaminathan Gandham Edmond Jonathan Sunithi Alexandar Mani Shyamkumar Nidugula Keshava Vinu Moses Krishna Prabhu |
| author_facet | Ganesh Swaminathan Gandham Edmond Jonathan Sunithi Alexandar Mani Shyamkumar Nidugula Keshava Vinu Moses Krishna Prabhu |
| author_sort | Ganesh Swaminathan |
| collection | DOAJ |
| description | Purpose: We studied the clinico-radiological features and treatment outcomes of patients with aggressive spinal haemangiomas. Methods: We undertook a retrospective review of 24 patients with aggressive spinal haemangiomas managed at our centre from 2004 to 2016. The cohort was divided into two groups. Group1 included patients managed from 2004 to 2009 while Group 2 was those treated between 2010 and 2016. Clinicoradiological features and treatment outcomes were studied. Results: Back pain (24/24) and myelopathy (18/24) were the most common presenting complaints. Over 80% (20/24) of patients, had involvement of the thoracic spine and more than 50% (13/24) had severe spasticity, being Nurick grade 4&5 at presentation. The various treatment modalities used were laminectomy with or without instrumented posterior fusion (10/24), corpectomy with instrumented fusion (10/24) and alcohol injection alone (4/24). Patients who were treated with surgery had significant clinical improvement at follow-up in both groups. Patients who underwent alcohol injection did not have any improvement in symptoms at follow-up. There was a change in our strategy in the later part of the series from a two staged anterior and posterior approach to a single staged posterior-only approach to address vertebral body disease with preoperative angioembolization. Conclusion: Haemangiomas are benign lesions with locally aggressive behavior in some cases. Results of conservative approaches such as alcohol injection in management of these lesions are discouraging. Aggressive surgical decompression combined with preoperative adjuncts such as angioembolization with or without stabilization reduces intra operative blood loss and results in good neurological recovery even in patients with severe myelopathy. |
| format | Article |
| id | doaj-art-b0990271d56e43309c27b5dea5dbb747 |
| institution | OA Journals |
| issn | 2772-5294 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj-art-b0990271d56e43309c27b5dea5dbb7472025-08-20T01:56:20ZengElsevierBrain and Spine2772-52942024-01-01410273610.1016/j.bas.2023.102736Surgical strategies in the management of aggressive spinal haemangiomas: Retrospective case series with literature review and a practical treatment algorithmGanesh Swaminathan0Gandham Edmond Jonathan1Sunithi Alexandar Mani2Shyamkumar Nidugula Keshava3Vinu Moses4Krishna Prabhu5Department of Neurological Sciences, Christian Medical College, Vellore, IndiaDepartment of Neurological Sciences, Christian Medical College, Vellore, IndiaDepartment of Radiodiagnosis, Christian Medical College, Vellore, IndiaDepartment of Radiodiagnosis, Christian Medical College, Vellore, IndiaDepartment of Radiodiagnosis, Christian Medical College, Vellore, IndiaDepartment of Neurological Sciences, Christian Medical College, Vellore, India; Corresponding author. Tel.: 04172 224889Purpose: We studied the clinico-radiological features and treatment outcomes of patients with aggressive spinal haemangiomas. Methods: We undertook a retrospective review of 24 patients with aggressive spinal haemangiomas managed at our centre from 2004 to 2016. The cohort was divided into two groups. Group1 included patients managed from 2004 to 2009 while Group 2 was those treated between 2010 and 2016. Clinicoradiological features and treatment outcomes were studied. Results: Back pain (24/24) and myelopathy (18/24) were the most common presenting complaints. Over 80% (20/24) of patients, had involvement of the thoracic spine and more than 50% (13/24) had severe spasticity, being Nurick grade 4&5 at presentation. The various treatment modalities used were laminectomy with or without instrumented posterior fusion (10/24), corpectomy with instrumented fusion (10/24) and alcohol injection alone (4/24). Patients who were treated with surgery had significant clinical improvement at follow-up in both groups. Patients who underwent alcohol injection did not have any improvement in symptoms at follow-up. There was a change in our strategy in the later part of the series from a two staged anterior and posterior approach to a single staged posterior-only approach to address vertebral body disease with preoperative angioembolization. Conclusion: Haemangiomas are benign lesions with locally aggressive behavior in some cases. Results of conservative approaches such as alcohol injection in management of these lesions are discouraging. Aggressive surgical decompression combined with preoperative adjuncts such as angioembolization with or without stabilization reduces intra operative blood loss and results in good neurological recovery even in patients with severe myelopathy.http://www.sciencedirect.com/science/article/pii/S277252942301024XAggressive spinal hemangiomasMyelopathyThoracic spineCorpectomy |
| spellingShingle | Ganesh Swaminathan Gandham Edmond Jonathan Sunithi Alexandar Mani Shyamkumar Nidugula Keshava Vinu Moses Krishna Prabhu Surgical strategies in the management of aggressive spinal haemangiomas: Retrospective case series with literature review and a practical treatment algorithm Brain and Spine Aggressive spinal hemangiomas Myelopathy Thoracic spine Corpectomy |
| title | Surgical strategies in the management of aggressive spinal haemangiomas: Retrospective case series with literature review and a practical treatment algorithm |
| title_full | Surgical strategies in the management of aggressive spinal haemangiomas: Retrospective case series with literature review and a practical treatment algorithm |
| title_fullStr | Surgical strategies in the management of aggressive spinal haemangiomas: Retrospective case series with literature review and a practical treatment algorithm |
| title_full_unstemmed | Surgical strategies in the management of aggressive spinal haemangiomas: Retrospective case series with literature review and a practical treatment algorithm |
| title_short | Surgical strategies in the management of aggressive spinal haemangiomas: Retrospective case series with literature review and a practical treatment algorithm |
| title_sort | surgical strategies in the management of aggressive spinal haemangiomas retrospective case series with literature review and a practical treatment algorithm |
| topic | Aggressive spinal hemangiomas Myelopathy Thoracic spine Corpectomy |
| url | http://www.sciencedirect.com/science/article/pii/S277252942301024X |
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