Purpose

We retrospectively study twenty-nine surgical cases of aggressive vertebral hemangiomas (AVHs) with neurological deficits and extradural compression to determine the optimal surgical treatment strategy for AVHs at a single institution.

Methods

Patients with AVHs with neurological deficits who underwent partial tumor resection plus decompression with or without vertebroplasty (VP), and radiotherapy between 2010 and 2021 were included in this study. Clinical characteristics, surgical outcomes, and follow-up data of the patients were reviewed retrospectively.

Results

Twenty-nine AVH cases with neurological deficits and spinal instability were included in this study and treated surgically. The mean operation time of patients with decompression surgery plus VP (Groupe A) was 215.9 (120-265 min), shorter than that of decompression surgery without VP (Group B) 240.2 (120-320 min). Intraoperative blood loss was 273.3 (100–550 mL) in group A and 635.3 (200–1600 mL) in group B. In addition, a significant reduction in blood loss was observed in group A compared to the group B (p=0.0001). All patients experienced immediate pain relief and improvement in their neurological symptoms. Neurological function was assessed by the Frankel score, ASIA score, and the visual analogue scale (VAS) pain score decreased from 7.4 (4-9) to 1.3 (0-3). Of twenty-nine patients in this study, only 7% (2/29 patients) showed signs of recurrence.

Conclusion

Decompression plus VP achieve good tumor control and decrease surgical complication. Preoperative vascular embolization and VP can reduce intraoperative bleeding in the treatment of AVH surgery. Moreover, postoperative radiotherapy seems to be a good technique to prevent tumor recurrence.

中文翻译：

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侵袭性椎体血管瘤的手术选择：病例系列、文献综述和治疗建议

目的

我们回顾性研究了 29 例伴有神经功能缺损和硬膜外压迫的侵袭性椎体血管瘤 (AVH) 手术病例，以确定单个机构针对 AVH 的最佳手术治疗策略。

方法

本研究纳入了 2010 年至 2021 年间接受部分肿瘤切除加减压伴或不伴椎体成形术 (VP) 和放射治疗的伴有神经功能缺损的 AVH 患者。回顾性分析患者的临床特征、手术结果和随访资料。

结果

本研究纳入了 29 例患有神经功能缺损和脊柱不稳的 AVH 病例，并接受了手术治疗。减压手术加VP（A组）患者的平均手术时间为215.9（120-265分钟），比减压手术不加VP（B组）240.2（120-320分钟）短。A 组术中失血量为 273.3（100-550 mL），B 组为 635.3（200-1600 mL）。此外，与 B 组相比，A 组失血量显着减少（p= 0.0001） 。所有患者的疼痛立即缓解，神经症状得到改善。神经功能通过Frankel评分、ASIA评分和视觉模拟评分（VAS）疼痛评分从7.4（4-9）下降至1.3（0-3）。在本研究的 29 名患者中，只有 7%（2/29 名患者）出现复发迹象。

结论

减压加VP可实现良好的肿瘤控制并减少手术并发症。术前血管栓塞和VP可以减少AVH手术治疗中的术中出血。此外，术后放疗似乎是预防肿瘤复发的好技术。