-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the usefulness of preoperative percutaneous injections in vertebral hemangiomas.
Four patients presented with complicated vertebral hemangioma (spinal cord compression in three cases, intermittent spinal claudiction in one case). A three-part treatment was performed: initially, arterial embolization in three cases; 1 day later, percutaneous injections of methyl methacrylate into the vertebral body to strengthen it and of N-butyl cyanoacrylate into the posterior arch to optimize hemostasis during surgery; finally, the day after percutaneous injections, decompressive laminectomy and epidural hemangioma excision (when present).
Laminectomy was performed with minimal blood loss. The epidural component present in three cases was excised without any difficulty. The follow-up (average, 20 months) showed no evidence of vertebral collapse.
Percutaneous injections of methyl methacrylate and N-butyl cyanoacrylate might be useful before surgery for vertebral hemangiomas.
American Journal of Neuroradiology 02/1996; 17(1):137-42. · 2.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Vertebral hemangiomas can cause difficult-to-treat neurological complications. We report our experience with three such cases. Patients no. 1 and 2 were females aged 64 and 71 years, respectively; patient no. 1 had a two-year history of weakness in the lower limbs and patient no. 2 had a five-month history of back pain. Both these patients had a pyramidal syndrome in the lower limbs. Patient no. 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 magnetic resonance imaging confirmed this diagnosis and showed that patients 1 and 2 had an anterior epidural hemangioma opposite T8 impinging on the spinal cord. In patients 1 and 2, treatment consisted in embolization of T8 followed by transpedicular injection of 6 cc of methylmethacrylate into the body of T8. One cubic centimeter of histoacryl was also injected in each lamina. The third patient had a similar vertebroplasty procedure without prior embolization since he had no epidural hemangioma. One patient (no. 1) developed intercostal neuralgia of several hours duration after the procedure. All three patients subsequently underwent laminectomy (T7-T8 with removal of the epidural hemangioma 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 within 48 hours in patient 3.(ABSTRACT TRUNCATED AT 250 WORDS)
Revue du Rhumatisme 02/1994; 61(1):16-22.
-
[show abstract]
[hide abstract]
ABSTRACT: Vertebroplasty is an effective new radiologic procedure consisting of the percutaneous injection of a biomaterial, usually methyl methacrylate, into a lesion of a vertebral body. This technique allows marked or complete pain relief and bone strengthening in most cases. The principal indications for vertebroplasty are osteolytic metastasis and myeloma, painful or aggressive hemangioma, and osteoporotic vertebral collapse with debilitating pain that persists despite correct medical treatment. Radiography and computed tomography must be performed in the days preceding vertebroplasty to assess the extent of vertebral collapse, the location and extent of the lytic process, the visibility and degree of involvement of the pedicles, the presence of cortical destruction or fracture, and the presence of epidural or foraminal stenosis caused by tumor extension or bone fragment retropulsion. Leakage of methyl methacrylate during vertebroplasty may cause compression of adjacent structures and necessitate emergency decompressive surgery; thus, the procedure should be performed only in a surgical center. The decision to perform vertebroplasty should be made by a multidisciplinary team because the choice between vertebroplasty, surgery, radiation therapy, medical treatment, or a combination thereof depends on a number of factors. Radiologists need to be aware of the various indications for vertebroplasty and of potential future developments and applications of the procedure.
Radiographics 18(2):311-20; discussion 320-3. · 2.85 Impact Factor
