Goyal M, Mishra N K, Sharma A, Gaikwad S B, Mohanty B K, Sharma S
Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi.
AJNR Am J Neuroradiol. 1999 Jun-Jul;20(6):1091-6.
Many therapeutic techniques have been used for the treatment of symptomatic vertebral hemangiomas (SVH), and each has its own limitations. Our objective was to evaluate the therapeutic efficacy of alcohol ablation for treating these lesions.
Fourteen patients with SVH were treated by injection of absolute alcohol into the lesion via the percutaneous transpedicular route under CT guidance. Symptoms before treatment included neurologic deficit in 13 patients and debilitating pain in one. All patients underwent preprocedural MR imaging. All patients had clinical and MR imaging follow-up (14 patients at 48-96 hours and 2 months; six at 9-15 months). Results were divided into excellent (resumption of work, alleviation of pain), good (significant improvement), and failure of treatment categories on the basis of subjective assessment of clinical improvement. Clinical improvement/deterioration was correlated with MR-revealed changes.
All patients showed transient deterioration of neurologic status after alcohol ablation. Subsequently, excellent results were seen in five patients and eight were in the good category. One patient in whom treatment failed also developed a complication (paravertebral abscess). Four of the eight patients with good results had preprocedural cord changes. Total follow-up ranged from 5 to 31 months, with 11 patients showing stable improvement. One patient developed recurrent hemangioma within a month. Another patient became symptomatic after initial good response, secondary to the collapse of the involved vertebral body. Good correlation was found between clinical improvement and reduction of epidural soft-tissue masses on MR images. Cord signal alteration seen on MR images in four treated patients, however, did not show any change after treatment.
Alcohol ablation is an effective management option for symptomatic vertebral hemangiomas. Although encouraging results were seen in almost 86% of our patients, a longer follow-up period still is needed to assess the stability of improvement. Potential complications include vertebral collapse and infection.
许多治疗技术已被用于治疗有症状的椎体血管瘤（SVH），且每种技术都有其自身的局限性。我们的目的是评估酒精消融治疗这些病变的疗效。
14例SVH患者在CT引导下经皮经椎弓根途径向病变内注射无水酒精进行治疗。治疗前症状包括13例神经功能缺损和1例顽固性疼痛。所有患者均接受术前磁共振成像检查。所有患者均进行了临床和磁共振成像随访（14例患者随访48 - 96小时和2个月；6例随访9 - 15个月）。根据临床改善的主观评估，结果分为优（恢复工作、疼痛缓解）、良（显著改善）和治疗失败类别。临床改善/恶化与磁共振显示的变化相关。
所有患者在酒精消融后均出现神经功能状态的短暂恶化。随后，5例患者效果为优，8例为良。1例治疗失败的患者还出现了并发症（椎旁脓肿）。8例效果为良的患者中有4例术前脊髓有改变。总随访时间为5至31个月，11例患者显示持续改善。1例患者在1个月内出现血管瘤复发。另1例患者在最初反应良好后出现症状，继发于受累椎体塌陷。临床改善与磁共振图像上硬膜外软组织肿块缩小之间存在良好相关性。然而，4例接受治疗患者磁共振图像上显示的脊髓信号改变在治疗后未出现任何变化。
酒精消融是治疗有症状椎体血管瘤的一种有效管理选择。尽管我们近86%的患者取得了令人鼓舞的结果，但仍需要更长的随访期来评估改善的稳定性。潜在并发症包括椎体塌陷和感染。
