Vascular Myelopathies - Vascular Malformations of the Spinal Cord: Presentation and Endovascular Surgical Management

Louis P. Caragine, Jr., MD, PhD, Van V. Halbach, MD, Perry P. Ng, MD, Christopher F. Dowd, MD


Semin Neurol. 2002;22(2) 

In This Article

Spinal Hemangiomas

Spinal hemangiomas are the most common benign spinal neoplasms, often located in the thoracic and lumbar spine, with a peak incidence of occurrence in the fourth to sixth decades. They are relatively common, found in 11% of autopsy series.[37] Sixty percent are asymptomatic without gender preference.[38] Symptomatic hemangiomas are more common in women and present with back pain, radicular pain, or spinal cord compression. Acute symptoms occur from compression fracture, epidural extension and sudden mass effect, and hemorrhage.

MRI demonstrates a hyperintense lesion in the vertebral body seen on T1- and T2-weighted images.[39] MRI may demonstrate expansion to include the posterior elements of the spinal column, invasion of the spinal canal, and encroachment of the spinal cord.[40,41] Plain radiographs exhibit a coarse-striated appearance of the vertebral body, and CT reflects a "polka dot" appearance.

Radiation therapy appears highly beneficial and safe in the treatment of pain caused by vertebral hemangiomas and even for epidural extension to some degree.[42,43,44,45,46] Percutaneous injection of ethanol under fluoroscopic guidance has also been efficacious in the treatment of pain. Encouraging results were seen in 86% of patients in one study,[47] provided the dose was less than 15 mL[48] and provided that pretreatment test injection of contrast medium was retained by the hemangioma.[49] Preoperative embolization with methyl methacrylate, followed by laminectomy and/or vertebrectomy for mass effect and stabilization, is another treatment option.[50]