Pre-operative Embolization of Aggressive Vertebral Hemangioma

Introduction: Most cases of vertebral hemangioma (VH) are accidentally discovered which can be managed conservatively. When patients present with persistent pain, the options of minimally invasive treatment should be considered, as the high vascularity of the lesion itself makes surgical intervention relatively challenging, with high risk of blood loss. Therefore, traditional surgical techniques are typically reserved for patients with neural compression and neurological deficit.
Trans-arterial embolization (TAE) can be introduced as a single treatment option, or in combination with other lines, either as a curative line of management, or as a pre-operative step to reduce intra-operative blood loss. However, there is no fixed algorithm for treatment, which makes decision making more complicated and potentially inconsistent.

Methods: Patients who were managed for aggressive vertebral hemangioma in a tertiary referral center were reviewed from 2014 through 2023. All clinical, radiological, procedural and epidemiological data were retrieved. Patients with missing files or incomplete follow up were excluded. Patients who were managed conservatively were excluded.

Results: Nine patients were diagnosed and managed for aggressive vertebral hemangioma, six of them underwent surgical decompression, two patients underwent vertebroplasty with embolization, and one patient underwent trans-arterial embolization alone. Out of the six surgical cases, three patients underwent pre-operative embolization. All the patients who underwent pre-operative embolization were involving dorsal spine including one case of dorsolumbar region. Only one case involved cervical spine region, this case underwent only trans-arterial embolization.

Conclusion : Pre-operative embolization for cases who undergoing surgical procedure for aggressive vertebral hemangioma is a feasible technique for reducing intra-operative blood loss during surgical procedure, also it is considered a stand-alone line of management for patients with intractable pain with no neuronal compression.