Symptomatic vertebral hemangiomas: treatment by means of direct intralesional injection of ethanol.
OBJECTIVE
To describe the technique and results of injecting ethanol directly into symptomatic vertebral hemangiomas.


METHODS
Eleven patients with paraplegia (n = 6) or radiculopathy (n = 5) due to vertebral hemangioma were treated by means of injecting ethanol (5-50 mL) directly into the lesion with computed tomographic (CT) guidance. CT angiograms were essential prior to treatment to identify functional vascular spaces of the hemangioma and direct needle placement.


RESULTS
All hemangiomas were obliterated completely at follow-up angiography and gadolinium-enhanced magnetic resonance imaging. Five of six patients with paraplegia recovered completely: One who was treated recently was walking with assistance. Four of five patients with radiculopathy improved. No immediate complications were associated with ethanol injection. The two patients who received the largest volumes of ethanol, 42 and 50 mL, developed pathologic fractures of the involved vertebrae 4 and 16 weeks after treatment.


CONCLUSIONS
Direct injection of ethanol into symptomatic vertebral hemangioma is an effective and safe treatment, provided the dose is less than 15 mL.
Doppman
J L
JL
Department of Diagnostic Radiology, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bldg 10, Rm 1C660, Bethesda, MD 20892-1182, USA. jdoppman@nih.gov
Oldfield
E H
EH
Heiss
J D
JD
D000328:Adult; D000368:Aged; D000792:Angiography; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003287:Contrast Media; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000209:etiology; D005682:Gadolinium; D006391:Hemangioma / Q000098:blood supply / Q000150:complications / Q000628:therapy*; D006801:Humans; D015552:Injections, Intralesional; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009339:Needles; D010264:Paraplegia / Q000209:etiology / Q000628:therapy; D010523:Peripheral Nervous System Diseases / Q000209:etiology / Q000628:therapy; D015641:Radiography, Interventional; D012597:Sclerosing Solutions / Q000008:administration & dosage / Q000627:therapeutic use*; D016103:Spinal Fractures / Q000209:etiology; D013125:Spinal Neoplasms / Q000098:blood supply / Q000150:complications / Q000628:therapy*; D013126:Spinal Nerve Roots / Q000473:pathology; D013904:Thoracic Vertebrae / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D003287:Contrast Media; D012597:Sclerosing Solutions; D000431:Ethanol; D005682:Gadolinium