Spine Unit, Département Des Neurosciences Cliniques, Service de Neurochirurgie, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
Neurosurgical Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Naples, Italy.
Eur Spine J. 2020 Dec;29(12):3179-3186. doi: 10.1007/s00586-020-06404-9. Epub 2020 Apr 10.
Vertebral hemangiomas (VH) account for 2-3% of all spinal tumors. The majority is incidentally found on radiographic studies: 1% present with pain and/or neurologic deficits. We report our experience with the multidisciplinary management of aggressive symptomatic thoracic VH by concomitant intraoperative sclerotization with sodium tetradecyl sulfate (STS), vertebroplasty, posterior decompression (with/without fusion) and surgical resection in a hybrid operating room (HR) equipped with a rotational scanner and a radiolucent operating table.
Patients admitted with aggressive spinal VH between 2007 and 2018 were included. Data regarding demographics, presenting symptoms, location of the lesion, preoperative embolization, length of the surgery, estimated blood loss (EBL) as well as follow-up (FU) were retrieved.
Five patients were included (three females, mean age 65 years; range 59-75). Three patients presented with a myelopathy and two mechanical thoracic pain. All patients underwent a single-stage percutaneous sclerotization and vertebroplasty followed by a surgical decompression associated with epidural intralesional injection of STS and subtotal resection of the epidural lesion. Two patients had preoperative embolization. Mean procedural duration was 338 min (range 210-480 min). Four patients had marginal EBL, one patient had 500 ml EBL. Patients had no evidence of lesion recurrence or progression at the end of the follow-up.
The single-stage multimodal management of aggressive symptomatic VH is safe and effective. It allows for a direct intraoperative sclerotherapy combined with maximal tumor resection, resulting in reduced blood loss. The use of STS as a direct intraoperative sclerotizing agent is safe and reliable.
椎体血管瘤（VH）占所有脊柱肿瘤的 2-3%。大多数是在影像学研究中偶然发现的：1%的患者有疼痛和/或神经功能缺损。我们报告了在配备旋转扫描仪和透光手术台的杂交手术室（HR）中，通过同时进行术中硬化剂治疗（十四烷基硫酸钠 [STS]）、椎体成形术、后路减压（伴/不伴融合）和手术切除来治疗侵袭性症状性胸 VH 的多学科管理经验。
纳入 2007 年至 2018 年间因侵袭性脊柱 VH 入院的患者。检索了人口统计学数据、临床表现、病变部位、术前栓塞、手术时间、估计失血量（EBL）以及随访（FU）。
共纳入 5 例患者（3 例女性，平均年龄 65 岁；范围 59-75 岁）。3 例患者表现为脊髓病，2 例为机械性胸背痛。所有患者均行单阶段经皮硬化治疗和椎体成形术，随后行手术减压，硬膜外腔内注射 STS，并对硬膜外病变进行次全切除。2 例患者术前进行了栓塞。平均手术时间为 338 分钟（范围 210-480 分钟）。4 例患者有边缘性 EBL，1 例患者 EBL 为 500ml。随访结束时，所有患者均未见病变复发或进展。
侵袭性症状性 VH 的单阶段多模态管理是安全有效的。它允许直接进行术中硬化治疗，并结合最大程度的肿瘤切除，从而减少出血量。STS 作为直接术中硬化剂的使用是安全可靠的。
