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Neurology (Expert Forum)
Vertebral hemangioma
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Vertebral hemangioma
by mnguy, Jun 23, 2003 12:00AM
I have a vertebral hemangioma at T-3. In 1998 I noticed numbness in my toes and bottoms of my feet, which over a few weeks moved up my legs. There was growing weakness in my legs, and numbness across my waistline. I had a laminectomy (T2-T4), the area surrounding the spinal cord was widened, and the T-2 vertebra was filled with methacrylate. Symptoms returned within 6 months, and I returned for surgery that removed some excess methacrylate that was compressing the spinal cord, as well as for further widening of the area surrounding the spinal cord.
In 1991, symptoms again returned, and I was scheduled for surgery that would remove the hemangioma and the vertebra, and would reconstruct the vertebra. This surgery was aborted due to excessive bleeding. Embolization of arteries missed a major feeder, now thought to be the aorta, because of the high pressure that the bleeding was demonstrating. The surgery only cleaned out the area around the spinal cord once again. I then received radiation treatment to try to "kill" the tumor. I have been told I have received all the radiation I can tolerate in that area.
Once again I am beginning to experience the numbness creeping up my legs. (There probably has been damage done to the spinal cord, because the numbness in my toes never went away completely.) I am reluctant to follow the surgical path one more time, because of the possible reconstruction and the general nature of the amount of surgery required.
Would I be candidate for injection of the tumor with ehanol? I have read about this procedure and am curious whether it would be useable in my case. Any other thoughts on surgery or other procedures would be appreciated.
In 1991, symptoms again returned, and I was scheduled for surgery that would remove the hemangioma and the vertebra, and would reconstruct the vertebra. This surgery was aborted due to excessive bleeding. Embolization of arteries missed a major feeder, now thought to be the aorta, because of the high pressure that the bleeding was demonstrating. The surgery only cleaned out the area around the spinal cord once again. I then received radiation treatment to try to "kill" the tumor. I have been told I have received all the radiation I can tolerate in that area.
Once again I am beginning to experience the numbness creeping up my legs. (There probably has been damage done to the spinal cord, because the numbness in my toes never went away completely.) I am reluctant to follow the surgical path one more time, because of the possible reconstruction and the general nature of the amount of surgery required.
Would I be candidate for injection of the tumor with ehanol? I have read about this procedure and am curious whether it would be useable in my case. Any other thoughts on surgery or other procedures would be appreciated.
Doctor's Answer
by CCF-Neuro-M.D.-JT, Jun 29, 2003 12:00AM
There have been a number of studies and case reports showing that when properly performed, ethanol injections can be helpful and safe for treatment/devascularization of vertebral hemangiomas. However, a known side effect is a compression fracture of the vertebra which is quite painful for the patient. In one study, the patients who experienced this had to undergo surgical removal of the vertebra. Fortunately, the ethanol injection was thought to have decreased the blood loss during the surgery. As you have had extensive procedures/surgeries, I am unsure as to whether or not you are a candidate for this procedure. That's ultimately going to up to the surgeon who reviews your films and prior procedures in detail. But it is certainly worth a shot for you to get a neurosurgical consult or interventional neuroradiology consult at a major academic center to see if you are. Again, the technique and experience of your surgeon are very very important to ensure a safe and successful procedure. Best of luck.
