VERTEBROPLASTY WITH SURGICAL DECOMPRESSIO N FOR THE TREATMENT OF AGGRESSIVE VERTEBRAL HEMANGIOMAS - A REPORT OF 3 CASES

Vertebral hemangiomas can cause difficult-to-treat neurological compli cations. We report our experience with three such cases. Patients n de grees 1 and 2 were females aged 64 and 71 years, respectively; patient n degrees 1 had a two-year history of weakness in the lower limbs and patient n degrees 2 had a five-month history of back pain. Both these patients had a pyramidal syndrome in the lower limbs. Patient n degre es 3 was a 61 year old male with a one-year history of left sciatica. Roentgenograms were suggestive of a hemangioma occupying the entire T8 (cases 1 and 2) or L5 (case 3) vertebra. Computed tomography and magn etic resonance imaging confirmed this diagnosis and showed that patien ts 1 and 2 had an anterior epidural hemangioma opposite T8 impinging o n the spinal cord. In patients 1 and 2, treatment consisted in emboliz ation of T8 followed by transpedicular injection of 6 cc of methylmeth acrylate into the body of T8. One cubic centimeter of histoacryl was a lso injected in each lamina. The third patient had a similar vertebrop lasty procedure without prior embolization since he had no epidural he mangioma. One patient (n degrees I) developed intercostal neuralgia of several hours duration after the procedure. Ail three patients subseq uently underwent laminectomy (T7-T8 with removal of the epidural heman gioma in cases 1 and 2, L5 in case 3). The pyramidal syndrome resolved within 15 days in patients 1 and 2; the nerve root pain resolved with in 48 hours in patient 3. Six months after treatment, patients 1 and 3 were free of symptoms and patient 2 reported mechanical low back pain ; neurological findings were normal in all three cases. In our opinion , this multidisciplinary therapeutic approach is effective and safe. V ertebroplasty strengthens the vertebra, allowing to perform only limit ed surgery. Injection of histoacryl in the laminae improves the safety of laminectomy.