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Images in Neurosciences
10 (
4
); 672-674
doi:
10.1055/s-0039-1700611

Aggressive Vertebral Hemangioma Causing Acute Spinal Cord Compression

Neurosurgery Unit, Card. G. Panico Hospital, Tricase, Italy
Department of Neuroscience, Mental Health, and Sense Organs, Faculty of Medicine and Psychology, “Sapienza” University of Rome, Rome, Italy
Address for correspondence Sokol Trungu, MD Via Pio X 4 Tricase, Italy s_trungu@hotmail.com
Licence
This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Disclaimer:
This article was originally published by Thieme Medical and Scientific Publishers and was migrated to Scientific Scholar after the change of Publisher.

A 46-year-old woman presented to our emergency department with sudden onset of lower extremity weakness after physical activity. She referred only dorsal back pain before these symptoms. Neurologic examination revealed weakness 2/5 of lower limbs, hyperreflexia of deep tendon reflex of lower limbs, hypoesthesia under D7 level, and no sphincteric dysfunction. A computed tomography scan showed an accentuation of trabecular markings within the vertebral body and areas of lysis (Figs. 1A F). Contrast-enhanced magnetic resonance images show diffuse abnormal marrow signal throughout the T6 vertebral body with epidural components with spinal cord compression (Fig. 1B H).

Fig. 1 Sagittal (A) and axial (F) computed tomography images demonstrating accentuation of trabecular markings within the vertebral body and areas of lysis involving the entire T6 vertebral body. Sagittal T1-weighted (B); sagittal (C) and axial (G) T2-weighted; sagittal (D), coronal (E), and axial (H) contrast-enhanced magnetic resonance images showing a T6 aggressive hemangioma with epidural extension and severe anterior cord compression.

Fig. 1 Sagittal (A) and axial (F) computed tomography images demonstrating accentuation of trabecular markings within the vertebral body and areas of lysis involving the entire T6 vertebral body. Sagittal T1-weighted (B); sagittal (C) and axial (G) T2-weighted; sagittal (D), coronal (E), and axial (H) contrast-enhanced magnetic resonance images showing a T6 aggressive hemangioma with epidural extension and severe anterior cord compression.

She underwent surgery on the same day through a mini-open decompression and percutaneous short posterior fixation (Fig. 2). No complications occurred after surgery with full recovery of neurological symptoms. Radiotherapy was perfomed after 4 weeks with resolution of dorsal back pain.

Fig. 2 Sagittal (A) and axial (B-D) postoperative computed tomography images demonstrating the posterior decompression and short pedicle screw fixation.

Fig. 2 Sagittal (A) and axial (B-D) postoperative computed tomography images demonstrating the posterior decompression and short pedicle screw fixation.

Vertebral hemangiomas (VH) are benign and generally asymptomatic primary vascular tumors of bone.1 2 Rarely, these lesions can cause symptoms due to cord compression as a result of bone expansion, erosion through cortex, fracture, or hematoma.3 Despite our long-standing recognition of aggressive VH, there is still a controversy regarding the optimal treatment strategy, and numerous therapeutic options have been described: embolization, surgery, radiotherapy, vertebroplasty, or a combination of them.4 5 6 7 8 9

Conflict of Interest

None declared.

Funding None.

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