Rai Ravi Ranjan, Shah Siddharth, Deogaonkar Kedar, Dalvie Samir
Department of Orthopaedics, P D Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra. India.
J Orthop Case Rep. 2018 Mar-Apr;8(2):33-37. doi: 10.13107/jocr.2250-0685.1038.
Asymptomatic vertebral hemangiomas are common, but extension into the spinal canal causing cord compression with neurologic symptoms is rare.
Case 1:A 20-year-old male patient presented with difficulty in walking for 6 months with gradually progressive weakness of both the lower limbs. On examination, upper motor neuron signs were present in both the lower limbs with a sensory level below T8 and no bladder involvement. Magnetic resonance imaging (MRI) showed a vascular tumor arising from T6 lamina and pedicle and compressing the cord. Pre-operative computerized tomogram angiography and embolization of the tumor was done, followed by decompression, stabilization of the spine, and vertebroplasty. Postoperatively, the patient received radiotherapy. Case 2: A 71-year-old male patient presented with the recurrence of vertebral hemangioma and cord compression. He had a history of hemangioma with cord compression 13 years back, which was treated by embolization, followed by decompression and fixation. The patient had gradually improved neurologically to normal activities. He was asymptomatic till 7 months back when he noticed difficulty in walking. On examination, pyramidal signs were found to be positive. MRI revealed an expansile lesion at T7 vertebra which was causing compression of the spinal cord. Pre-operative embolization, followed by decompression, stabilization, and vertebroplasty was performed. He also received radiotherapy postoperatively. The diagnosis of benign capillary hemangioma was made after histopathological examination. Neurological recovery was almost complete in both the cases. At6-month follow-up after surgery, both the patients were able to perform all the activities of daily living.
Aggressive vertebral hemangiomas causing progressive neurological deficit should be treated with surgical decompression, stabilization, and vertebroplasty. Pre-operative angiography, embolization, and post-operative low-dose radiation therapy are recommended.
无症状性椎体血管瘤很常见，但延伸至椎管并导致脊髓受压伴神经症状的情况罕见。
病例1：一名20岁男性患者，行走困难6个月，双下肢逐渐进行性无力。检查发现双下肢存在上运动神经元体征，感觉平面在T8以下，膀胱未受累。磁共振成像（MRI）显示一个起源于T6椎板和椎弓根的血管性肿瘤压迫脊髓。术前进行了计算机断层血管造影和肿瘤栓塞，随后进行减压、脊柱稳定和椎体成形术。术后患者接受了放疗。病例2：一名71岁男性患者，出现椎体血管瘤复发和脊髓受压。他13年前有血管瘤伴脊髓受压病史，当时接受了栓塞治疗，随后进行了减压和固定。患者神经功能逐渐改善至能正常活动。直到7个月前他发现行走困难时一直无症状。检查发现锥体束征阳性。MRI显示T7椎体有一个膨胀性病变，压迫脊髓。术前进行了栓塞，随后进行减压、稳定和椎体成形术。他术后也接受了放疗。组织病理学检查后诊断为良性毛细血管瘤。两例患者神经功能恢复几乎完全。术后6个月随访时，两名患者均能够进行所有日常生活活动。
导致进行性神经功能缺损的侵袭性椎体血管瘤应采用手术减压、稳定和椎体成形术治疗。建议术前进行血管造影、栓塞，术后进行低剂量放射治疗。
