Document Detail


Treatment of vertebral hemangiomas with absolute alcohol (ethanol) embolization, cord decompression, and single level instrumentation: a pilot study.
MedLine Citation:
PMID:  21099721     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Vertebral hemangiomas (VH) are the most common lesions of the vertebral column.
OBJECT: To evaluate the role of intraoperative ethanol embolization, surgical decompression, and instrumented fusion in VH presenting with myelopathy.
METHODS: This is was a prospective study of single-level symptomatic VH with cord compression. Exclusions were as follows: pathological fractures, deformity, or multilevel pathologies. Surgery consisted of intraoperative bilateral pedicular absolute alcohol injection and laminectomy at the level of pathology followed by a short-segment instrumented fusion using pedicle screws.
RESULTS: Ten patients (mean, 26.8 ± 18.11; range, 10-68 years; 8 females) were treated with use of this technique. Clinical features included myelopathy with motor and sensory involvement in all (4 paraplegic), sphincter involvement (8), and severe local pain (5). The preoperative American Spinal Injury Association (ASIA) scores were A (3), B (1), and C (6). All had pan vertebral body VH with severe cord compression. The mean surgical time was 102 ± 22 minutes; average blood, 296 ± 90.82 mL. Mean amount of absolute alcohol injected was 12.6 ± 4.7 mL (1 requiring 25 mL). Immediate embolization was achieved in all patients allowing laminectomy and soft-tissue hemangioma removal. Postsurgery, all patients showed improvement (sphincters improved in 4) at a follow-up ranging 12 to 26 months (transient neurological deterioration in 1). Postsurgery ASIA scores were D (5) and E (5) at last follow-up. Two patients showed evidence of bone sclerosis on follow-up CT scans at 1.2 and 1.5 years.
CONCLUSION: This procedure seems to be a safe, efficient method to treat VH with severe cord compression. It seems to serve the purpose of providing embolization, cord decompression, and rigid fusion at the same sitting.
Authors:
Pankaj Singh; Nalin K Mishra; Hari Har Dash; Rajender K Thyalling; Bhawani S Sharma; Chitra Sarkar; P Sarat Chandra
Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  68     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-14     Completed Date:  2011-04-13     Revised Date:  2011-09-29    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  78-84; discussion 84     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Child
Decompression, Surgical / methods
Embolization, Therapeutic / methods*
Ethanol / therapeutic use*
Female
Hemangioma / surgery*
Humans
Male
Middle Aged
Pilot Projects
Spinal Fusion / methods
Spinal Neoplasms / surgery*
Young Adult
Chemical
Reg. No./Substance:
64-17-5/Ethanol
Comments/Corrections
Comment In:
Neurosurgery. 2011 Aug;69(2):E502; author reply E502   [PMID:  21471836 ]

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