Pre-surgical embolization followed by decompression in atypical aggressive spinal hemangioma involving posterior elements

Find out how Dr Ahmad Saima treated a pre-surgical embolization followed by decompression in atypical aggressive spinal hemangioma involving posterior elements

Case Presentation

10 y / f / presented with inability to walk and pain; symptoms having been progressive and developed over 3 months. Bladder and bowel are intact.
Grade 1 power in both left and right lower limbs

Pre-surgical Embolization followed by decompression in Atypical aggressive spinal hemangioma involving posterior elements

Imaging findings

Images were obtained from a 10-year-old girl who presented with pain and paresthesia in both lower limbs, grade 1 power in both lower limbs.

Preoperative images (panels A-F) showed an expansive lytic lesion (A (spine radiograph) at the D11 vertebral body with compression of the posterior epidural component; sagittal MR images (panels B, C D) showed the vertebral lesion to be hyperintense on T2 and fat saturation phase and hypointense on T1WI.

Pre-surgical embolization with PVA particles

Pre-surgical embolization (panels A–C): selective AP projection at D11 showing intense tumor blush. Selective AP projection at D10 showing ASA arising one level above D11.

Post-embolization angiogram at D11 showing total obliteration of the vertebral hemangioma feeder artery.

Pre-surgical embolisation is performed with a diagnostic catheter – C2 Cobra 4Fr and PVA particles (250-350u)

Post OP X-ray

Spine (AP & lateral)

After posterior decompression

Total blood loss is 500 ml

After the operation, the patient started walking without support and his power improved immediately.