Shamhoot Ebrahim Ahmed, Balaha Ahmed Mohammed, Ganna Ahmed Atef
Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Egypt.
Asian J Neurosurg. 2020 Oct 18;15(4):919-925. doi: 10.4103/ajns.AJNS_291_20. eCollection 2020 Oct-Dec.
There are different surgical modalities designed to manage aggressive vertebral hemangioma (VH) that causes neurological symptoms. The selection of the best approach is still controversial. It is crucial to safely achieve neurological recovery with the elimination of the risk of recurrence. The combined use of surgical decompression and vertebroplasty is one of the surgical modalities that are used to manage these cases.
From January 2012 to January 2019, nine patients with aggressive VH were retrospectively included in the study. All of them were operated upon using combined surgical decompression and vertebroplasty. We evaluated all the patients preoperatively, immediate postoperative, 1 month, and 12 months later. Clinical and radiological outcomes were assessed.
Affected spinal levels were dorsal in six cases and lumbar in three cases. There was no postoperative worsening of the preoperative neurological status. For the cases presented with sciatica, the mean VAS score has dropped from 8.33 preoperatively to 2.67 postoperatively. One month later, all of them are free from the radicular pain. For the cases presented with myelopathy, they regain their motor power in both lower limbs over a period of 4 weeks with a mean Nurick grade of 1.17. The postoperative radiological studies revealed near total occlusion of the VH with the maintenance of the vertebral body height. No clinical or radiological signs of spinal instability or recurrence are observed over the period of follow-up.
The combined use of surgical decompression and vertebroplasty is considered a safe and effective modality in the management of aggressive VHs.
有多种不同的手术方式用于治疗引起神经症状的侵袭性椎体血管瘤（VH）。最佳手术方式的选择仍存在争议。在消除复发风险的同时安全实现神经功能恢复至关重要。手术减压与椎体成形术联合应用是用于处理这些病例的手术方式之一。
2012年1月至2019年1月，9例侵袭性VH患者被回顾性纳入本研究。所有患者均接受了手术减压与椎体成形术联合治疗。我们在术前、术后即刻、术后1个月及12个月对所有患者进行了评估。评估了临床和影像学结果。
受累脊柱节段6例为胸椎，3例为腰椎。术后神经功能状态未比术前恶化。对于出现坐骨神经痛的病例，视觉模拟评分（VAS）均值从术前的8.33降至术后的2.67。1个月后，所有患者均无神经根性疼痛。对于出现脊髓病的病例，他们在4周内双下肢恢复运动能力，平均Nurick分级为1.17。术后影像学检查显示VH几乎完全闭塞，椎体高度得以维持。随访期间未观察到脊柱不稳定或复发的临床及影像学征象。
手术减压与椎体成形术联合应用被认为是治疗侵袭性VH的一种安全有效的方式。
