J Cerebrovasc Endovasc Neurosurg.  2025 Mar;27(1):40-49. 10.7461/jcen.2025.E2024.12.003.

Multi-modal management of aggressive vertebral hemangioma: A single center experience

• Farouk M
• Kassem MA
• Ezzeldein A
• Ameen MM
• Elmokadem AH
• Elsherbini MM

• KMID: 2567042
• DOI: http://doi.org/10.7461/jcen.2025.E2024.12.003

Abstract

Objective
This study aims at spotlighting different lines of management of aggressive vertebral hemangioma (VH) through a retrospective analysis of single center experience.
Methods
Patients diagnosed with aggressive VHs in a tertiary referral center were reviewed from 2014 through 2024. Data of patients who met the inclusion criteria were analyzed. Patients of all ages, both sexes, and all varieties of clinical presentation were included, only patients who underwent at least one intervention were included.
Results
The study included nine patients, comprising six females and three males, with a mean age of 29.3 years (ranging from 14 to 46). Six patients underwent Trans-arterial embolization (TAE), of whom five underwent further surgical procedures, while one patient found TAE to be sufficient as a stand-alone management technique. Eight patients underwent surgical management, five of whom were pre-operatively embolized.
Conclusions
Aggressive VHs are rare, and their management is challenging. Most cases require a multi-modal management, especially when presented with neurological deficit. Pre-operative embolization and/or vertebroplasty are safe and useful tools to decrease intra-operative bleeding of such a vascular pathology in cases undergoing open surgical procedures.

Keyword

Vertebral hemangioma; Laminectomy; Therapeutic embolization; Vertebroplasty; Sclerotherapy

Figure

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  Fig. 1. (A) (sagittal) and (B) (axial) post-contrast MRI showed aggressive D6 hemangioma with leak into the spinal canal causing cord compression. (C-F) Conventional catheter angiography showed feeders from right D6, right D7, left D6, and left D7 intercostal arteries (respectively). (G-J) After embolization of all feeders using particles, marked reduction of vasculature is noted. (K) Post-operative CT scan showing the fenestration bone window for hematoma evacuation, cement vertebroplasty is noticed as well allover vertebral body. MRI, magnetic resonance imaging; CT, computed tomography

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  Fig. 2. (A) Sagittal T2FS MRI showed D12 leaking hemangioma compressing the conus. (B) intraoperative image of surgical procedure which included D12 laminectomy and long segment fixation using transpedicular screws. (C) and (D) antroposterior and lateral radiograph shows results after vertebroplasty, decompression and posterior fixation. MRI, magnetic resonance imaging

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