Kothari Ajay R, Situt Nishad V, Hadgaonkar Shailesh R, Aiyer Siddharth N, Bhilare Pramod D, Sancheti Parag K
Department of Spine Surgery, Sancheti Institute for Orthopedics and Rehabilitation, Pune, 411005, Maharashtra, India.
Dean, Sancheti Institute for Orthopedics and Rehabilitation, Pune, 411005, Maharashtra, India.
Spinal Cord Ser Cases. 2025 Jul 22;11(1):20. doi: 10.1038/s41394-025-00717-x.
Vertebral hemangioma (VH) is the most common angiomatous tumor usually asymptomatic and is incidentally noticed on MRI. The incidence of VH is rare in the pediatric population. The extraosseous extension is termed an Aggressive Vertebral Hemangioma (AVH) and these often need surgical management. Intraoperative stereotactic navigation for tumor excision helps in planning- localizing the tumor and delineating its margins.
A 14-year-old boy presented with thoracic myelopathy signs. The MRI scan suggests T1 and T2 hyperintense signals within the T6 vertebral body with extramedullary extradural space occupying the lesion. The CT scan showed a "polka dot" appearance. Preoperative endovascular embolization followed by surgical decompression with posterior instrumented stabilization under O-arm navigation and tumor excision was planned. Cystic extradural lesion excised and vertebroplasty done at T6 level. Histopathology slides confirmed hemangioma.
The most common age of involvement is between 30 and 70 years it is rarely seen in the pediatric age group. To the best of our knowledge, fewer than 20 cases of pediatric aggressive vertebral hemangiomas have been reported. Based on a review of pediatric AVH only 4 patients have been treated with preoperative vascular embolization followed by surgical decompression and stabilization. O-arm navigated AVH excision and vertebroplasty has never been described in the literature; this being the first case. It also aids in the identification of tumor margins along with real-time monitoring of adequate resection.
椎体血管瘤（VH）是最常见的血管瘤性肿瘤，通常无症状，多在MRI检查时偶然发现。VH在儿童人群中的发病率较低。骨外扩展型被称为侵袭性椎体血管瘤（AVH），这类肿瘤通常需要手术治疗。术中立体定向导航辅助肿瘤切除有助于规划、定位肿瘤并确定其边界。
一名14岁男孩出现胸段脊髓病症状。MRI扫描显示T6椎体T1和T2高信号，髓外硬膜外间隙有占位性病变。CT扫描显示“斑点”样外观。计划先行术前血管内栓塞，然后在O型臂导航下进行后路器械固定减压及肿瘤切除手术。切除了囊性硬膜外病变，并在T6节段进行了椎体成形术。组织病理学切片证实为血管瘤。
VH最常见的发病年龄在30至70岁之间，在儿童年龄组中很少见。据我们所知，报道的儿童侵袭性椎体血管瘤病例少于20例。根据对儿童AVH的回顾，仅有4例患者接受了术前血管栓塞，随后进行手术减压和固定。文献中从未描述过O型臂导航下的AVH切除及椎体成形术；此为首例。它有助于识别肿瘤边界，并实时监测肿瘤是否完全切除。
