Introduction
Aggressive vertebral hemangiomas (AVH), while rare, can present significant challenges to neurosurgical teams due to their potential for causing pain, neurological deficit, and even pathological fractures through their expansive nature. Traditional management approaches ranged from pre-operative transarterial embolization to surgical excision, radiotherapy, and percutaneous alcohol or methyl methacrylate injection.
A breakthrough study from Dharmaram, India, redefines treatment efficacy by introducing a per-operative glue embolization technique combined with surgical decompression. This article delves into the research findings, comparing outcomes against established treatment modalities and advocating for this innovative method as a superior treatment for AVH.
Study Synopsis
Published in the journal ‘Interventional Neuroradiology’ (DOI: 10.1177/1591019919842849), the study documented the treatment of five patients with symptomatic dorsal level vertebral hemangioma using per-operative glue embolization. This procedure was executed after an initial laminectomy and direct contrast tumorogram via fluoroscopy. By injecting varied glue concentrations through a spinal needle inserted transpedicularly, complete embolization was possible in all cases.
Adjunct surgical decompression of the epidural component followed, with necessary posterior spinal stabilization in two patients. Notably, this innovative method resulted in significantly reduced blood loss during the procedure.
Results and Outcomes
The study reported substantial improvements across all patients in a follow-up period ranging from 12 to 48 months. There was a reduction in the size of the epidural component, relief from cord compression symptoms, and remarkable recovery from neurological deficits without any recurrence.
This synergy of per-operative glue embolization and surgical decompression presented a safe, efficient, and patient-beneficial approach. It showcased potential as a preferred alternative for AVH management, especially when considering long-term outcomes.
Comparative Analysis
The study’s comparison of the multimodal approach against other management strategies revealed compelling outcomes in favor of the per-operative embolization technique. Compared with methods like alcohol ablation, the glue embolization offers immediate and lasting tumor devascularization and lower incidences of recurrent symptoms. Similarly, it bypasses the potential malignant transformation risk associated with radiotherapy and provides a less invasive option than aggressive total surgical resection.
Discussion
The study’s clinical impact resonates within the neurosurgery community, offering a clear protocol for treating AVH effectively. The expertise from the National Institute of Mental Health and Neuro Sciences team reveals that the sophistication in imaging, intervention radiology, and neurosurgical techniques can converge to improve patient outcomes substantially.
Keywords
1. Aggressive Vertebral Hemangioma Treatment
2. Per-operative Glue Embolization
3. Surgical Decompression of Spine
4. Neurological Deficit Management
5. Spinal Tumor Blood Loss Reduction
References
1. Prabhuraj A R, Mishra Ajit A, Mishra Rakesh Kumar RK, Pruthi Nupur N, Saini Jitender J, Arvinda H R. (2019). Per-operative glue embolization with surgical decompression: A multimodality treatment for aggressive vertebral haemangioma. Interv Neuroradiol, 25(5), 570-578. DOI: 10.1177/1591019919842849.
2. Healy M, Herz DA, Pearl L. (1983). Spinal hemangiomas. Neurosurgery, 13(6), 689-691.
3. Vasudeva VS, Chi JH, Groff MW. (2016). Surgical treatment of aggressive vertebral hemangiomas. Neurosurg Focus, 41(1), E7.
4. Goyal M, Mishra NK, Sharma A, et al. (1999). Alcohol ablation of symptomatic vertebral hemangiomas. AJNR Am J Neuroradiol, 20(7), 1091-1096.
5. Yao KC, Malek AM. (2013). Transpedicular N-butyl cyanoacrylate-mediated percutaneous embolization of symptomatic vertebral hemangiomas. J Neurosurg Spine, 18(5), 450–455.
Conclusion
With the inherent limitations of existing treatment modalities for AVH, the conducted study by the National Institute of Mental Health and Neuro Sciences presents a breakthrough with its minimally invasive and highly effective modality. The per-operative glue embolization technique, coupled with meticulous surgical decompression, sets a new clinical precedent, promising a transformative leap in the management of symptomatic vertebral hemangiomas.
Advancements like these not only signify progress in the field of interventional neuroradiology but also represent hope for patients suffering from these debilitating spinal lesions. As this study suggests, with the right approach, AVH can be managed effectively, giving patients the relief they need with minimal risk of recurrence, thus improving their quality of life significantly.