Alcohol ablation of symptomatic vertebral hemangiomas

BACKGROUND AND PURPOSE: Many therapeutic techniques have been used for the treatment of symptomatic vertebral hemangiomas (SVH), and each has its own limitations. Our objective was to evaluate the therapeutic efficacy of alco hol ablation for treating these lesions. METHODS: Fourteen patients with SVH were treated by injection of absolute a lcohol into the lesion via the percutaneous transpedicular route under CT g uidance, Symptoms before treatment included neurologic deficit in 13 patien ts and debilitating pain in one, All patients underwent preprocedural MR im aging, All patients had clinical and MR imaging follow-up (14 patients at 4 8-96 hours and 2 months; six at 9-15 months). Results were divided into exc ellent (resumption of work, alleviation of pain), good (significant improve ment), and failure of treatment categories on the basis of subjective asses sment of clinical improvement. Clinical improvement/deterioration was corre lated with MR-revealed changes, RESULTS: All patients showed transient deterioration of neurologic status a fter alcohol ablation, Subsequently, excellent results were seen in five pa tients and eight were in the good category. One patient in whom treatment f ailed also developed a complication (paravertebral abscess). Four of the ei ght patients with good results had preprocedural cord changes. Total follow -up ranged from 5 to 31 months, with 11 patients showing stable improvement , One patient developed recurrent hemangioma within a month. Another patien t became symptomatic after initial good response, secondary to the collapse of the involved vertebral body. Good correlation was found between clinica l improvement and reduction of epidural soft-tissue masses on MR images. Co rd signal alteration seen on MR images in four treated patients, however, d id not show any change after treatment. CONCLUSION: Alcohol ablation is an effective management option for symptoma tic vertebral hemangiomas. Although encouraging results were seen in almost 86% of our patients, a longer follow-up period still is needed to assess t he stability of improvement, Potential complications include vertebral coll apse and infection.