Background: Aggressive vertebral hemangiomas causing spinal compression are rare, and there is controversy with regard to treatment. The purpose of this study was to evaluate the clinical results of patients with aggressive vertebral hemangiomas at a mean follow-up of more than 10 years after total excision and discuss the treatment options for the tumors.
Methods: We performed a retrospective review of patients with aggressive vertebral hemangiomas who were treated with total excision. The surgeries were carried out on five patients (average age 47 years). In all five patients, the tumor was in the thoracic spine and was causing myelopathy with extraosseous extension. There were three tumors of type 5 and two of type 6 according to Tomita's surgical classification of spinal tumors. The tumors were assessed using magnetic resonance imaging (MRI), and the clinical results were evaluated.
Results: All of the tumors showed low-intensity or low-isointensity signal on T1-weighted MRI. All five patients had a combination of preoperative transarterial embolization and total excision including tumor margin. Total en bloc excisions were performed in two patients. En bloc and piecemeal combined total excisions were performed in two patients. Piecemeal total excision was performed in one patient. Intraoperative blood loss ranged from 1580 to 3400 ml (mean 2424 ml). There were no perioperative complications. According to the Japanese Orthopaedic Association score, the myelopathy improved after the surgery from 5.3 +/- 2.9 to 9.8 +/- 1.7 (total of 11 points). None of the patients have had a recurrence at a mean followup of 135.2 months (range 92-163 months).
Conclusions: We performed a combination of preoperative transarterial embolization and total excision for aggressive vertebral hemangiomas with extraosseous extension that were causing spinal cord compression in all five cases. The results in the long-term follow-up have proved satisfactory.