Raffaele De Marco1,2, Gianluca Piatelli3, Andrea Rossi4, Luigi Aurelio Nasto5, Marco Pavanello3. 1. Department of Neurosurgery, IRCCS Istituto "G. Gaslini", via G. Gaslini 5, 16148, Genoa, Italy. r_dema@outlook.it. 2. Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute e Della Scienza" University Hospital, University of Turin, Via Cherasco 15, 10126, Turin, Italy. r_dema@outlook.it. 3. Department of Neurosurgery, IRCCS Istituto "G. Gaslini", via G. Gaslini 5, 16148, Genoa, Italy. 4. Interventional Radiology and Neuroradiology Unit, IRCSS Istituto "G. Gaslini", via G.Gaslini 5, 16148, Genoa, Italy. 5. Department of Paediatric Orthopaedics, IRCCS Istituto "G. Gaslini", via G. Gaslini 5, 16148, Genoa, Italy.
Abstract
PURPOSE: To discuss a treatment algorithm for vertebral hemangioma in children. METHODS: Vertebral hemangioma (VH) is a rare cause of low back pain in children. In most cases, VHs present as incidental findings and do not require invasive diagnostic procedure. In case of symptomatic presentation, different approaches can be used. Over the years, we have developed a treatment algorithm for VH in children based on our clinical experience. In this manuscript, we propose a stepwise approach to treatment of VHs based on tumor extension and the degree of spinal cord/nerves compression with or without neurological deficit. RESULTS: According to the proposed protocol, we discuss two cases of aggressive VH treated at our institution by a multidisciplinary team. The first case is about a young girl treated with percutaneous one-level posterior instrumentation followed by medical adjuvant therapy for an L4 "Stage 3" VH. The second case is about an 8-year-old boy with rapidly progressive myelopathy due to T11 "Stage 4" VH treated with a combined anterior and posterior surgery (i.e., posterior decompression and fusion followed by vertebrectomy and expandable cage placement) after preoperative arterial embolization. CONCLUSION: Given the lack of international guidelines and consensus with regard to treatment of VHs in children, we believe our proposal for a stepwise approach combining clinical and radiological characteristics of the lesion may help guide treatment of this condition in children.
PURPOSE: To discuss a treatment algorithm for vertebral hemangioma in children. METHODS: Vertebral hemangioma (VH) is a rare cause of low back pain in children. In most cases, VHs present as incidental findings and do not require invasive diagnostic procedure. In case of symptomatic presentation, different approaches can be used. Over the years, we have developed a treatment algorithm for VH in children based on our clinical experience. In this manuscript, we propose a stepwise approach to treatment of VHs based on tumor extension and the degree of spinal cord/nerves compression with or without neurological deficit. RESULTS: According to the proposed protocol, we discuss two cases of aggressive VH treated at our institution by a multidisciplinary team. The first case is about a young girl treated with percutaneous one-level posterior instrumentation followed by medical adjuvant therapy for an L4 "Stage 3" VH. The second case is about an 8-year-old boy with rapidly progressive myelopathy due to T11 "Stage 4" VH treated with a combined anterior and posterior surgery (i.e., posterior decompression and fusion followed by vertebrectomy and expandable cage placement) after preoperative arterial embolization. CONCLUSION: Given the lack of international guidelines and consensus with regard to treatment of VHs in children, we believe our proposal for a stepwise approach combining clinical and radiological characteristics of the lesion may help guide treatment of this condition in children.
Authors: Frank L Acosta; Christopher F Dowd; Cynthia Chin; Tarik Tihan; Christopher P Ames; Philip R Weinstein Journal: Neurosurgery Date: 2006-02 Impact factor: 4.654