Total en bloc spondylectomy of locally aggressive vertebral hemangioma in a pediatric patient
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CASE REPORT
Total en bloc spondylectomy of locally aggressive vertebral hemangioma in a pediatric patient Tristan Brunette-Clément 1 & Alexander G. Weil 1 & Daniel Shedid 2 Received: 27 November 2019 / Accepted: 28 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Vertebral hemangiomas are benign, highly vascular spinal lesions that are extremely rare in the pediatric population. We report a pediatric case of symptomatic vertebral hemangioma treated with total en bloc spondylectomy. Our objective is to demonstrate that en bloc spondylectomy is feasible and addresses some pitfalls of traditional total tumor resection. Methods Our patient presented with bilateral lower limb and perineal paresthesia, paraparesis, as well as urinary retention. Locally aggressive vertebral hemangioma was the presumed diagnosis following imaging. The patient received partial angioembolization to reduce the vascularization of the lesion then underwent total en bloc spondylectomy of T8 under intraoperative neuromonitoring. The intervention was well tolerated. Results Postoperative course was marked by clinical improvement and only transient, treatable complications. On 1-year followup, the patient is neurologically intact, and imaging reveals adequate position of hardware, good alignment, and no tumor recurrence. Conclusion Total en bloc spondylectomy is a feasible procedure in pediatric patients. It reduces local recurrence through reduction of tumor cell contamination and residual tumor and thus may avoid postoperative radiotherapy in select cases. It may also enhance functional neurological recovery by allowing circumferential decompression and increased spinal cord blood flow. Keywords Vertebral hemangioma . Pediatric . Total en bloc spondylectomy . Spine
Introduction Vertebral hemangiomas are common, benign, highly vascular spinal lesions that frequently occur during adulthood [1, 4, 6, 9]. They may be cavernous, capillary, or mixed type [2, 3, 9] and typically involve one vertebra in the thoracic spine [9]. The vertebral body, posterior elements, or both may be affected [9]. These tumors are usually asymptomatic and discovered incidentally [1, 9]. However, they may become locally aggressive and cause symptoms, including back pain or neurological deficit
* Alexander G. Weil [email protected] 1
Division of Neurosurgery, Sainte-Justine University Hospital Center, 3175, chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
2
Division of Neurosurgery, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
through compression of the spinal cord [6]. Vertebral hemangiomas are extremely rare in the pediatric age group, with only a limited number of cases reported in the literature [9]. Various treatments are available for tumors causing medically refractory pain or myelopathy, such as radiotherapy, arterial embolization, percutaneous sclerotherapy, vertebroplasty, decompressive surgery without tumor resection, and subtotal or total tumor resection [1, 6,
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