胸腰椎侵袭性血管瘤，影像学表现不典型。
Aggressive vertebral hemangioma of the thoracic spine without typical radiological appearance.
机构信息
Orthopaedic Department, Peking University Third Hospital, No 49 North Garden Road, HaiDian District, Beijing, China.
出版信息
Eur Spine J. 2012 Oct;21(10):1994-9. doi: 10.1007/s00586-012-2349-1. Epub 2012 Jun 26.
PURPOSE
Vertebral hemangioma (VH) is virtually vascular malformation, which is usually asymptomatic. Only 3.7 % of VH may become active and symptomatic, and 1 % may invade the spinal canal and/or paravertebral space. Treatment protocols for active or aggressive VHs are still in controversy. Reported treatments include radiotherapy, vertebroplasty, direct alcohol injection, embolization, surgery and a combination of these modalities.
METHODS
A 41-year-old lady was presented with 18 month history of intermittent back pain. CT revealed T5 osteolytic lesion with epidural and paravertebral extension. The first CT guided biopsy yielded little information.
RESULTS
Histopathological diagnosis of the second biopsy was VH. Vertebroplasty, posterior decompression and fixation were performed followed by postoperative radiotherapy. Her symptoms were resolved immediately after the operation. At 12 months follow-up, no recurrence was detected by CT with contrast enhancement.
CONCLUSION
Surgical decompression, vertebroplasty and fixation are safe and effective for aggressive VH. More attention is needed in determining the algorithm for the diagnosis and treatment of aggressive VH.
目的
椎体血管瘤（VH）实际上是一种血管畸形，通常无症状。只有 3.7%的 VH 可能变得活跃和有症状，1%的 VH 可能侵犯椎管和/或椎旁间隙。对于活动性或侵袭性 VH 的治疗方案仍存在争议。报道的治疗方法包括放疗、椎体成形术、直接酒精注射、栓塞、手术以及这些方法的联合应用。
方法
一位 41 岁的女性，间歇性背痛 18 个月。CT 显示 T5 溶骨性病变，伴有硬膜外和椎旁延伸。第一次 CT 引导下活检提供的信息很少。
结果
第二次活检的组织病理学诊断为 VH。随后进行了椎体成形术、后路减压和固定，并进行了术后放疗。她的症状在手术后立即得到缓解。12 个月随访时，CT 增强扫描未见复发。
结论
对于侵袭性 VH，手术减压、椎体成形术和固定是安全有效的。在确定侵袭性 VH 的诊断和治疗算法时需要更多关注。
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