Mousavi Seyed Reza, Akbari Somayeh, Rasekhi Alireza, Kazeminezhad Ali, Motlagh Mohammadhadi Amir Shahpari, Taherpour Sanaz
Department of Neurosurgery, Shiraz University of medical science, Shiraz, Iran; Shiraz Neuroscience Research Center, Shiraz University of medical science, Shiraz, Iran.
Histomorphometry and Stereology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Int J Surg Case Rep. 2023 Apr;105:108027. doi: 10.1016/j.ijscr.2023.108027. Epub 2023 Mar 22.
Different treatments are available for aggressive vertebral hemangioma [AVH], but a consensus is yet to be reached about the best therapeutic approach.
To explore the possibility that selecting a less aggressive therapeutic approach for AVH decreases the intraoperative and postoperative complications while providing similar clinical, radiographic, and disease-free survival results to more aggressive therapeutic methods.
We report the case of an AVH of the thoracic spine at the T5 level, treated via perioperative selective arterial embolization plus surgical decompression via laminectomy and reconstruction with polymethylmethacrylate (PMMA) vertebroplasty.
The patient was a 17-year-old male referred to our center with the chief complaint of low back pain from two months earlier, without any response to analgesics, and with neurologic manifestations as paraparesis (one month) and progressive sphincter problems (one week). Upon imaging, the impression was an aggressive spinal tumor with cord compression.
After the operation, the patient's pain immediately improved, and his neurologic manifestations progressively improved.
The patient started walking with help about three weeks after the operation. Roughly six months later, he achieved a complete neurological recovery. At present, about two years following the operation, he has a normal life without any neurological problems.
Based on our experience with AVH, the selection of less aggressive therapeutic approaches such as perioperative diagnostic angiography and selective embolization decrease the intraoperative and postoperative complications like intraoperative bleeding and neurological injury, while achieving similar clinical, radiographic, and disease-free survival outcomes to more aggressive therapeutic methods.
侵袭性椎体血管瘤（AVH）有多种不同的治疗方法，但对于最佳治疗方案尚未达成共识。
探讨为AVH选择侵入性较小的治疗方法是否能减少术中及术后并发症，同时在临床、影像学及无病生存率方面取得与侵入性更强的治疗方法相似的效果。
我们报告了一例T5水平的胸椎AVH病例，通过围手术期选择性动脉栓塞，联合椎板切除术进行手术减压，并使用聚甲基丙烯酸甲酯（PMMA）椎体成形术进行重建。
该患者为17岁男性，因两个月前出现下背部疼痛前来我院就诊，服用镇痛药无效，且伴有神经功能表现，如双下肢轻瘫（1个月）和进行性括约肌问题（1周）。影像学检查显示为侵袭性脊柱肿瘤伴脊髓受压。
术后患者疼痛立即改善，神经功能表现逐渐好转。
患者术后约3周开始在辅助下行走。大约6个月后，他实现了完全神经功能恢复。目前，术后约两年，他生活正常，无任何神经问题。
基于我们对AVH的治疗经验，选择侵入性较小的治疗方法，如围手术期诊断性血管造影和选择性栓塞，可减少术中及术后并发症，如术中出血和神经损伤，同时在临床、影像学及无病生存率方面取得与侵入性更强的治疗方法相似的效果。
